LIBRARY OF CONGRESS, 

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UNITED STATES OF AMEIU A. 






OBSTETRICAL NURSING 



FULLERTON. 



BY THE SAME AUTHOR. 

NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 



12mo. 284 Pages. 70 Illustrations. Cloth, $1.50. 



*%* The immediate success of Dr. Fulkrton's " Handbook of 
Obstetrical Nursing," a third edition of which has just been pub- 
lished, has encouraged her to prepare this manual on another and 
very important branch of the science and art of nursing. Dr. 
Fullerton has demonstrated that she not only knows what to say, 
but that she has the happy faculty of saying it in a plain, practical 
style that interests as well as instructs. 

Synopsis of Contents. — The Surgical Nurse — The Germ Theory 
of Disease — Asepsis and Antisepsis — Abdominal Section — The Pre- 
paration of the Room — The Preparation of Sponges — Sterilization 
of Instruments, etc—Preparation of the Patient — Preparation of 
Operator and Assistants — The Nurse's Duties During Operation — 
The Nurse's Duties After Operation and During Convalescence — 
Management of Complications — The Pelvic Organs in Women — 
Diseases of Women — General Nursing in Pelvic Diseases — Pre- 
parations for Gynaecological Examinations — Preparation for Gynae- 
cological Operations — Preparation of Patient, Operator, and Assist- 
ants — Duties of Nurse During Operation — Special Nursing in 
Gynaecological Operations — Diet for the Sick. 

From The Bulletin of Johns Hopkins Hospital. — "An excellent 
text-book for nurses. * * * The style is pleasant and readable. * * * 
Such an attempt to occupy a new field so successfully carried out is most praise- 
worthy." 

From the Philadelphia Medical News. — •' Dr. Fullerton has clearly 
discerned the requirements in the training of nurses for this special work, 
namely, the inculcation of knowledge that will give an intelligent idea of the 
work before them and the insistence upon habits of promptness and forethought. 
For both the physician and nurse this book presents the important points in a clear 
and impressive way." 

P. BLAKISTON, SON & CO., Publishers, Philadelphia. 



A HANDBOOK 



OF 



OBSTETRICAL NURSING 



FOR 



NURSES, STUDENTS, AND MOTHERS. 



COMPRISING THE COURSE OF INSTRUCTION IN OBSTETRICAL 

NURSING GIVEN TO THE PUPILS OF THE TRAINING 

SCHOOL FOR NURSES CONNECTED WITH THE 

WOMAN'S HOSPITAL OF PHILADELPHIA. 



BY 

ANNA M. FULLERTON, M.D., 

PHYSICIAN IN CHARGE OF, AND OBSTETRICIAN AND GYNAECOLOGIST TO, THE 
WOMAN'S HOSPITAL OF PHILADELPHIA, ETC. 



THIRD REVISED EDITION. ILLUSTRATED. 



PHILADELPHIA: 
P. BLAKISTON, SON & CO., 

IOI2 WALNUT STREET. 

1893. 






Copyright, 1892, by Anna M. Fullerton, M.D. 



PRESS OF WM. F FELL & CO.. 

1220-24 SANSOM STREET, 

PHILADELPHIA 



TO 

Dr. ANNA E. BROOMALL, 

PROFESSOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE 
OF PENNSYLVANIA, 

ATTENDING OBSTETRICIAN AND GYNAECOLOGIST, 

AND FORMER PHYSICIAN-IN-CHARGE, 

OF THE 

WOMAN'S HOSPITAL OF PHILADELPHIA, 

THIS VOLUME 
IS AFFECTIONATELY DEDICATED. 



PREFACE TO THIRD EDITION 



The present edition of this work has been revised 
by the addition of a chapter on pelvic anatomy and 
by the introduction of several important details in 
the application of modern methods of antisepsis to 
midwifery. Considerable new matter has also been 
introduced in the chapter on the "Ailments of Early 
Infancy." 

The fact that within three years this little book 
has reached its third edition, and that I have been 
asked to permit its translation into three foreign 
languages, would seem to prove that it has, to a 
gratifying extent, proved to its readers the value of 
scientific nursing in averting the dangers of child- 
birth and reducing the mortality of early infancy. 

ANNA M. FULLERTON. 



vn 



PREFACE TO SECOND EDITION. 



In this second edition of my book, the main 

revisions have been made in the chapter on the 

care of the new-born infant, in which I have 

endeavored to bring the subject up to the present 

standard of our knowledge. I would acknowledge 

in this connection the valuable aid afforded me by 

the articles of Dr. T. M. Rotch on the subject and 

the analytical work of Dr. H. Leffmann. I trust 

that these additions may serve to make life healthier 

and happier for infancy. 

ANNA M. FULLERTON. 
August, 1891. 



Vlll 



PREFACE 



. The teachings embodied in this little book are 
chiefly the substance of a series of lectures deliv- 
ered, yearly, by Dr. Anna E. Broomall to the nurse- 
pupils of the Woman's Hospital of Philadelphia. 

The methods advocated by Dr. Broomall are 
strictly observed in the practical work of the 
Maternity connected with the Woman's Hospital 
— a building mainly planned by Dr. Broomall and 
built during her administration as Physician-in- 
Charge of the Woman's Hospital. 

The excellent results attained by an adherence 
to these methods prove the value of cleanliness, 
antisepsis and eternal vigilance on the part of the 
nurse, in averting the dangers of childbirth and 
reducing the mortality of early infancy. 

The great importance of a thorough understand- 
ing of the many little details of scientific nursing 
on the part of the physician leads me to trust that 

ix 



X PREFACE. 

this little book may be of value to physician as 
well as nurse ; and since both of these must have 
the entire support, sympathy, and assistance of the 
patient in their efforts for her well-being, the direc- 
tions herein given as to preparations to be made, 
and rules of action to be observed, will, it is hoped, 
enable the patient to work in harmony with those 
who are working for her good. 

My thanks are due to Dr. Broomall for her 
kindly advice and encouragement in the comple- 
tion of this handbook, and to Dr. Louise L. Wylie 
for valuable assistance given in the preparation of 
the illustrations. 

ANNA M. FULLERTON. 

Woman's Hospital of Philadelphia, 
December^ 1889. 



CONTENTS. 



CHAPTER I. 

PAGE 

The Pelvis and Genital Organs, . . 17 



CHAPTER II. 
Signs of Pregnancy, 26 

CHAPTER III. 
Management of Pregnancy, 31 

CHAPTER IV. 
Accidents of Pregnancy, 52 

CHAPTER V. 
Germs and Antisepsis, 58 

CHAPTER VI. 
Application of Antisepsis to Confinement Nursing, 65 

CHAPTER VII. 
Preparations for the Labor, 77 

CHAPTER VIII. 
Signs of Approaching Labor, and the Process of Labor, ... 89 

xi 



Xll CONTENTS. 

CHAPTER IX. page 

Duties of the Nurse During Labor, 95 

CHAPTER X. 
Accidents and Emergencies of Labor, , 114 

CHAPTER XL 
Care of the New-born Infant, 132 

CHAPTER XII. 
Management of the Lying-in, 168 

CHAPTER XIII. 
Characteristics of Infancy in Health and Disease, 209 

CHAPTER XIV. 
Ailments of Early Infancy, 221 



LIST OF ILLUSTRATIONS. 



FIG. PAGE 

1. Normal Pelvis, ....'. 18 

2. External Genitalia, 20 

3. Cavity of Uterus and Fallopian Tubes, 22 

4. Abdominal Belt, . . . , 34 

5. Spiral Reverse Bandage of Lower Extremity, 38 

6. Nipple Protector, 43 

7. Jenness-Miller Chemilette, 44 

8. Jenness-Miller Divided Skirt, . 44 

9. Union Undergarment, 45 

10. Jenness-Miller Leglette, 45 

11. The Equipoise Waist, . . .-« 47 

12. Occlusion Dressing (Dr. Garrigues'), 79 

13. Nightingale Wrap, 81 

14. Sylvester's Method of Resuscitation (First Movement), . . 118 

15. Sylvester's Method of Resuscitation (Second Movement), 119 

16. Schultze's Method of Resuscitation (First Movement), . . 121 

17. Schultze's Method of Resuscitation (Second Movement), . 122 

18. Position of Patient in Hemorrhage after Labor, 128 

19. Home-made Bathtub and Crib, 141 

20. The Lactometer, 148 

21. Sterilizer (Dr. Louis Starr), 160 

22. Graduated Nursing Bottle (Dr. Louis Starr), . ... 163 

23. Rubber Nipple (Starr), 165 

24. Nipple Shield, 182 

25. Variously Shaped Nipples, 183 

26. Figure-of-Eight Bandage of One Breast, 184 

xiii 



XIV LIST OF ILLUSTRATIONS. 

FIG. PAGE 

27. Figure-of- Eight Bandage of Both Breasts, 185 

28. Garrigues' Breast Bandage, 186 

29. Breast Pump, 188 

30. Handkerchief Bandage of Breast, 189 

31. Worcester's Y-Bandage, 191 

32. Obstetrical Breast Support, 192 

^. Diagram Showing Eruption of Milk Teeth, 219 

34. Tarnier's Couveuse, 223 

35. Auvard's Couveuse (Interior View), 227 

36. Auvard's Couveuse (Exterior View), , 228 

37. Swaddled Baby, 229 

38. Single-bulb Syringe (Starr), 242 



"He shall gather the lambs with His arm and carry 

them in His bosom, and shall gently lead those that are 

with young. ' ' 

— Isaiah, Chap, xl, v. ii. 



OBSTETRICAL NURSING 



CHAPTER I. 



THE PELVIS AND GENITAL ORGANS. 

The pelvis is that part of the skeleton found The P elvis - 
between the lower end of the spinal column and 
the thigh bones. It consists of four bones, the 
sacrum, the coccyx, and the right and left innomi- 
nate or hip bones. These bones form a canal 
through which the child passes during labor. 

Various measurements or diameters are taken from ^ t s s ure " 
certain parts of the pelvis to determine the capacity 
of this canal. It is important that every pregnant 
woman should have her pelvis measured by the 
physician whom she expects to have attend her in 
labor, in order that it may be discovered whether 
her pelvis is at all under size, so that special pre- 
cautions may be taken in time to prevent difficulty 
in the delivery. These measurements should be 
taken not later than the seventh month of preg- 
nancy, as it may be desirable, for the sake of both 

'7 



i8 



OBSTETRICAL NURSING. 



Internal 

genital 

organs. 



External 

genital 

organs. 



mother and child, that the physician should induce 
premature labor. 

The canal of the pelvis contains the internal 
organs of generation, viz., the uterus, Fallopian tubes, 
and ovaries ; and the bladder and rectum besides. 

The external organs are called the pudenda or 
vulva. 

Immediately above the pubic bone, or anterior 



Fig. i. 




Normal Pelvis. 



Mons 
veneris. 

Labia 
majora. 



border of the pelvis, is a cushion of fat, usually 
covered with hair. This is called the " mons 
veneris. " On each side of the opening of the vulva 
are the "labia majora," or large lips. Lying be- 



THE PELVIS AND GENITAL ORGANS. 1 9 

neath these and concealed by them, in young 
women, are two thin folds of flesh, named the " labia 
minora " or " nymphae." They join together above, N y m P hse 
and at their junction is a small projecting body 
called the "clitoris." The small triangular space clltorls - 
between the clitoris and the nymphae is the vesti- 
bule. 

The opening of the urethra (the " meatus urina-J^H s us 
rius"), through which the urine escapes from the 
bladder, is in the middle of the lower border of the 
vestibule. It is very important that the nurse 
should know the exact position of the meatus 
urinarius, as she will frequently be called upon to 
pass the catheter. 

Below the vestibule is the orifice of the vagina, Vagina. 
the canal leading to the uterus or womb. In virgins 
a delicate membrane, usually crescentic in shape, 
blocks the entrance to the vagina. This is the 
hymen. 

The hymen is usually ruptured at marriage, but Hymen, 
a woman may be a virgin, yet have no hymen ; in 
some cases it persists even after marriage and 
offers an obstruction at childbirth. A woman who 
has borne children has a few fleshy projections at 
the orifice of the vagina, the only remains of the 
hymen, called the " carunculse myrtiformes." Be- 
tween the vulva and the anus is a mass of flesh, the 
space on the surface measuring one and one-half 



20 



OBSTETRICAL NURSING, 



Perineum. 



inches in length. During the birth of the child 
this becomes greatly distended, and thins like 
rubber. This is the perineum. It may be torn 



Fig. 




External Genitalia. 

i. The right large lip. 2. The fourchette. 3. Right nympha. 4. Clitoris. 
5. Urethral orifice. 6. Vestibule. 7. Orifice of vagina. 8. Hymen. 10. 
Mons veneris. 11. Anal orifice. 



during labor to a greater or less extent ; sometimes 
it is completely torn into the bowel. That part of 
the perineum in the virgin which forms the pos- 



THE PELVIS AND GENITAL ORGANS. 21 

terior border of the vulva is called the "fourchette." 

It is merely a fold of skin and is almost always 

torn in a first labor. Behind the perineum is the 

anus or orifice of the rectum, the lower part of the Anal orifice - 

bowel. 

The vagina is a canal connecting the external 
with the internal organs of generation. The uterus Uterus - 
is at the top of the vagina. In front of the uterus 
is the bladder, and behind and to the left the 
rectum. 

A secretion of mucus keeps the vagina moist. 
There should, however, be no discharge in a per- 
fectly healthy woman. During pregnancy, and as 
a result of ill-health or local inflammation, the 
natural secretion may be greatly increased, and the 
patient is then said to have " the whites." In labor ^™f s „ 
the discharge is very greatly increased, so as to aid 
the birth of the child. 

The uterus is a pear-shaped organ, three inches 
in length, one and one-half inches in breadth, and 
about one inch in thickness. It weighs a little 
over an ounce in its normal condition in a virgin. 
After child-bearing it remains larger and heavier 
than before. That portion of the uterus which 
communicates with the vagina is called the neck or 
cervix. The chief portion of the organ above this Cervix, 
is called the body, and the rounded upper surface 
the fundus. The opening in the cervix which 



22 



OBSTETRICAL NURSING. 



Os uteri. 



Fallopian 
tubes. 



communicates with the vagina is called the " os 
uteri." That portion of the cervix in front of the 
os uteri is the anterior lip, while that part which 
lies behind is the posterior lip. 

The Fallopian tubes are two canals which pass 
from each side of the upper portion of the uterus. 
They are from three to four and one-half inches 
long, and will admit the passage of a bristle. Each 



Fig 




Cavity of Uterus and Fallopian Tubes. 

A. Superior border of fundus of womb. B Cavity of the womb. C Cavity 
of the neck of the womb. D. Canal of the Fallopian tube. E. The fim- 
briated extremity. F. F. The ovaries. G. The cavity of the vagina. 



Ovaries. 



ends in a trumpet-shaped opening surrounded by 
a fringe of small projections called " fimbriae." 
This is called the fimbriated extremity. When the 
ovum (or egg) escapes from the ovary it is received 
by the Fallopian tube and reaches the cavity of 
the uterus in this way. 

The ovaries are two small flattened bodies about 



THE PELVIS AND GENITAL ORGANS. 23 

an inch long and half an inch thick. They lie 
about an inch from the fundus of the uterus on each 
side, in the folds of the broad ligament. The broad 
ligaments are folds of peritoneum, a thin glistening 
membrane which covers the uterus and all the 
pelvic organs, and by means of which the uterus 
is suspended in the pelvis. The bladder and rectum 
being covered with the same tissue, there is an 
intimate connection between the three, so that if 
one is deranged the others are likely to be also. 

The breasts are considered as belonging to the The breasts - 
external organs of generation. They are two 
glands situated on the front of the chest, one oh 
each side of the breast-bone. They vary in size 
and shape in different women, and during preg- 
nancy they enlarge greatly. They secrete milk for 
the nourishment of the child. The nipple at the 
apex of the gland is a conical- shaped projection. 
The milk-ducts all come toward it from the differ- 
ent parts of the breast and open on its surface. 
The areola is a pink or brown circle which sur- 
rounds the nipple. 

There is an intimate connection between the 
breasts and the uterus. Pain in the breast may be 
the result of disease of the uterus. The secretion 
of milk is called Jactation. 

Menstruation is a bloody discharge from the M 
uterus every month. It begins usually about the 



tion. 



24 OBSTETRICAL NURSING. 

age of fourteen and recurs every month except 
during pregnancy, or while a woman is nursing. 
It ceases at the change of life or menopause (be- 
tween forty-five and fifty). 

At puberty, that is when this function first ap- 
pears, the girl becomes a woman, the breasts en- 
large and the pelvis increases in size. The organs 
of generation become ready to perform the func- 
tions of reproduction. The menstrual flow recurs 
every twenty-eight days and lasts about four days. 
The quantity of blood lost at a period is from four 
to eight ounces. Different women vary much in 
this respect. The discharge is blood mixed with 
mucus. Its color is dark red. Any peculiarity 
in color, or the appearance of any clots in the dis- 
charge, will need to be noticed by the nurse and 
the discharge kept for the doctor's inspection. 
There is usually a feeling of discomfort at the men- 
strual period, with headache, pains in the back, 
breasts, etc. These symptoms are more severe in 
some women than in others. 
Conception. Conception most usually takes place immediately 
or very soon after a period. This is not an invari- 
able rule, as women have become pregnant before 
menstruation has been established, or even after the 
menopause. They may also become pregnant 
while nursing. 

A nurse is so often questioned on these points 



THE PELVIS AND GENITAL ORGANS. 25 

that it is well for her to have information concern- 
ing them. Always endeavoring to discourage the 
inquisitiveness of mere prurient curiosity, she 
should aim to give wise counsel concerning matters 
of which her patient may hesitate to speak to her 
physician. In doing so the nurse should, however, 
speak to the physician of any matters of importance 
concerning the condition of the patient, which she 
may thus learn, and ask his counsel as to the advice 
she should give. 



CHAPTER II 



SIGNS OF PREGNANCY. 



Suspicious 
signs. 



pr| n n anc ^he sl S ns °f pregnancy may be divided into 

three classes : the suspicious, the probable, and the 
certain. 

Under the head of suspicious signs may be 
classed the many nervous sensations which are apt 
to accompany early pregnancy ; as, general discom- 
fort, sudden changes of temperature, headache, 
toothache, giddiness, faintness, changes in disposi- 
tion. 

Of the probable signs one of the earliest and 

mlnsTru- 11 of most constant is the stoppage of the monthly flow 
in a person who has been regular. This may be, 
however, caused by other conditions than preg- 
nancy. Thus, change in one's mode of living, a 
new climate, or general ill-health may produce the 
same result. In the early months of marriage we 
may also have an irregularity in menstruation 
where there is no pregnancy. On the other hand, 
in rare instances, we may have the monthly flow 
persisting for some months or throughout the entire 

26 



Probable 
signs 



ation. 



SIGNS OF PREGNANCY. 2J 

pregnancy. It is then generally scanty and short 
in duration. 

A deepening in the color of the vagina and vulva, ^i^f^ 
by which they take on a purplish hue, is another vag,na - 
sign, and is caused by the enlargement of the blood- 
vessels and a stoppage of the circulation, due to 
pressure from the enlargement of the uterus. This 
coloration may be caused to some extent by tumors. 

Increase in the size of the breasts occurs in the Dev fiop- 

ment of 

early months of pregnancy with a deposit of color- breasts - 
ing matter in the areola, or ring which surrounds 
the nipple. Some of this coloring matter seems to 
extend irregularly over the outer margin of the 
ring, and is called the " secondary areola" or 
" areola of Montgomery." With this distention of 
the breasts there is also a secretion found in them 
— a watery fluid, sometimes yellowish in color, 
known as " colostrum." 

Temporary distention of the breasts, with the 
accumulation of this secretion, may occur in a 
slighter degree as an accompaniment of menstrua- 
tion, or it may persist for a long time-after a woman 
has stopped nursing her infant. 

Enlargement of the abdomen, which begins Enlar gf- 

<=> » o ment of 

about the third month of pregnancy, is another abdomen - 
important sign. Yet this may also be caused by 
tumors, or by flatulence, or the deposit of fat in 
the abdominal walls. 



28 



OBSTETRICAL NURSING. 



Striae." 



Brown-line tumors, 
and mask" 
of preg- 
nancy. 



Morning 
sickness. 



" Quicken- 
ing." 



Marks upon the abdomen, due to the rapid 
stretching of the skin, sometimes occur in great 
numbers, and are called "striae," owing to the fact 
of their resemblance to the marks left by whip- 
lashes. These marks sometimes extend down 
upon the thighs. This, too, may be caused by 
The " brown line" of pregnancy is the 
deposit of pigment in the median line of the abdo- 
men. This may exist when there is no pregnancy, 
as also may the peculiar browning of the skin found 
in irregular patches over the face, particularly on 
the forehead, and called the "mask of pregnancy/' 

" Morning sickness," another sign, begins early 
in the second month or at the time of the first missed 
period. It is generally confined to the first three 
months and is largely a nervous symptom. It varies 
much, however, in degree and time of occurrence. 
Sometimes it is simply a slight feeling of sickness 
at the stomach occurring early in the morning ; 
again, it may persist throughout the entire day, or 
it may occur one day and not again for several 
days. Sometimes it continues throughout the 
entire pregnancy, and is then dangerous because of 
the constant loss of food. Sometimes it occurs 
early in the pregnancy, then disappears to reappear 
in the last month, when there is direct pressure 
upon the stomach. 

" Quickening" — or the appreciation of the move- 



SIGNS OF PREGNANCY. 29 

ments of the child by the mother — is another prob- 
able sign, and is first experienced about the middle 
of pregnancy. A woman who has previously borne 
children feels this sensation about two weeks earlier 
than one pregnant for the first time. 

There are other probable signs of pregnancy ^^.p^- 
which would come only under the observation of 
the physician. As they require considerable know- 
ledge of obstetrics and skill in the conducting of a» 
examination for the discovery of pregnancy, we 
will not do more than refer to them here. 



The positive signs of pregnancy as agreed upon \ 



Positive 
gns. 



by most obstetricians are but two : the direct ap- 
preciation of the parts of the child by touch, 
and the " foetal pulse," or heart sounds of the 
child. The " foetal pulse" is, as a rule, twice as fast 
as the pulse of the mother. It is hardly strong 
enough to be heard, even by experienced ears, 
much before the 5th month — or end of the 20th 
week — rarely heard well before the 24th week. 

The ordinary method of reckoning the probable Methods of 

y o x reckoning 

date of confinement is as follows : Learn on what terminati <> n 

or preg- 

day the last monthly flow began, then count three nancy - 
months backward (or nine months forward) and 
add seven days. For example, say that a woman 
was unwell last on March 15, counting three 
months back, gives December 15; add seven 
days, and we have December 22 as the probable 



30 OBSTETRICAL NURSING. 

date of her confinement. When, for any reason, 
it is impossible to make the calculation by this 
method, it may be computed by adding four and a 
half months to the date of quickening in the case 
of a woman pregnant for the first time, and five 
months in the case of one who has previously borne 
children. 

The third method, that of adding forty weeks, or 
t,en lunar months, to the date of conception is too 
uncertain to be of much practical use. Examina- 
tion of the patient by an intelligent physician who 
knows and appreciates the distinctive signs of the 
several months offers a fourth method of comput- 
ing the date of pregnancy. 



CHAPTER III. 
MANAGEMENT OF PREGNANCY. 

The management of pregnancy consists, for the^"^ 011 t0 
most part, in greater attention to the laws of health. health - 
The increased activity of all the organs of the body, 
together with the disturbances caused by pressure, 
necessitates this. 

Constipation is an almost invariable accompani- £™ stipa " 
ment of pregnancy. In the early months it is a 
sympathetic condition ; later, the effect of direct 
pressure upon the bowels. It is also, undoubtedly, 
in part due to the want of exercise. 

The treatment of constipation is the same as in 
other conditions, except that only mild laxatives are 
used. Regularity in attention to the bowels, a glass • 
of cold water at night and again in the morning, 
liquids (either milk or water), not taken with the 
meals, but in the intervals, a teaspoonful of common 
salt in the water occasionally, the use of uncooked 
fruit and coarse bread, the avoidance of starches and 
fine flour — all these are helpful in overcoming this 
condition. There is an objection to the use of 

31 



32 OBSTETRICAL NURSING. 

sugared fruits, as confections of fruit, senna leaves, 
etc., because of their liability to disturb the stomach. 
Prunes are, perhaps, the least objectionable ; licorice 
powder, because of the senna which it contains, is 
apt to cause griping pains. Rhubarb is, perhaps, 
the best of the mild laxatives. A small piece of 
rhubarb root, the size of a pea, may be taken at 
night, followed by a glass of water. If there is an 
objection to its taste, it may be taken in pill form. 

Cream of tartar, a half a teaspoonful being taken 
at night in a cup of cold water, is often efficient. 
In some cases it may be necessary to repeat the 
dose in the morning. 

Massage of the abdomen, so efficient in the man- 
agement of constipation, should never be resorted 
to in the pregnant state, as it is apt to excite uterine 
contractions, and may lead to a miscarriage. There 
is an objection to the too frequent use of enemata 
on the same ground ; also, the habit is thus ac- 
quired of depending upon this stimulus, and over- 
distention of the bowel is the result. It may be 
necessary, however, occasionally to alternate an 
enema with a laxative, especially when the patient 
suffers from piles. 
Diarrhoea. Diarrhoea is rather a rare disturbance of preg- 
nancy, but it sometimes occurs as a direct result of 
constipation — small, hardened masses forming in 
the bowel, known as " scybala," which produce an 



MANAGEMENT OF PREGNANCY. 33 

irritation of the mucous lining. The use of rhu- 
barb night and morning, in the manner described 
above, until all the masses are removed from the 
bowels, will serve to check the diarrhoea. 

Changes in the urinary organs are mainly due to Theurinar y 

o J c> J organs. 

direct pressure. In the first three months of preg- 
nancy there is direct pressure on the bladder, hence 
great irritation, due to interference with the disten- ^ n e bility 
tion of the bladder, producing a constant desire to bladder - 
pass water. For this the recumbent position is the 
only help. The uterus rises in the abdomen at the 
end of the third month, and the bladder being thus 
relieved from pressure, this symptom passes away. 

The tendency from the fourth to the ninth month Retention of 

J urine. 

is to the accumulation of urine, because there is 
less than the proper irritability of the bladder, the , 
organ being flattened between the uterus and the 
abdominal wall, and its walls thereby suffering a 
partial paralysis. 

In the last month there is incontinence of urine, Inconti - 

' nence 01 

because the pressure is so great that there is no urlne - 
room for the accumulation of urine. 

During labor there is pressure upon the neck of Retention of 

r r urine in last 

the bladder and urethra, leading to retention. This m ° nth of 

' o pregnancy. 

may exist for the last two weeks of pregnancy. 
Necessity for the use of the catheter is confined, as 
a rule, to this period. The distention of the blad- 
der may impede labor. With the drawing up of 
3 



34 



OBSTETRICAL NURSING. 



Excessive 
acidity of 
urine. 



the uterus the bladckr is drawn up and the urethra 
elongated, hence the use of the long rubber cathe- 
ter, known as the English catheter, will be neces- 
sary. Nos. 8 and 9 are those ordinarily used. 

Sometimes irritability of the bladder is due to 
excessive acidity of the urine. A physician will 
generally prescribe some alkali to overcome this 
condition, as a drop of liquor potassa in a table- 
spoonful of milk once in three or four hours, or the 



Fig. 4. 




Abdominal Belt. 



Use ot 
binder. 



Excoriation 
of vulva. 



use of mucilaginous drinks, as flaxseed tea, barley 
water, milk, etc., may relieve the distress. 

When the abdominal walls are much stretched 
and the uterus falls upon the bladder, this may be 
remedied by the use of the binder or an abdominal 
supporter. 

Incontinence of urine leads to the excoriation 
and reddening of the parts about the vulva. Fre- 



MANAGEMENT OF PREGNANCY. 35 

quent washing with warm water and borax or pure 
castile soap relieves the irritation. Diachylon or 
zinc ointment is best when an ointment is needed. 

Incontinence is sometimes the result of over- Over-dis- 

tention of 

distention of the bladder. Here the use of the bladder - 
catheter is indicated. 

A nurse, unless thoroughly experienced, should ^ e ° t f er 
never attempt passing the catheter in the case of a 
pregnant woman, as serious injury may be done to 
the soft parts in a bungling attempt. In all cases 
she should have the sanction of the physician before 
so doing. 

The kidneys are especially subjected to pressure ^® e s 
from the seventh to the ninth month of pregnancy. 
A passive congestion is thus produced, which may 
lead to the occurrence of albuminuria, or albumin Albumin - 

' una. 

in the urine. This is an evidence of a drain upon 
the blood which the physician needs to watch very 
carefully. It is customary, therefore, for physi- 
cians to examine the urine of patients whom they Exam j na : 

1 J tion of urine. 

expect to attend, at least once a week, from the 
seventh month on to the termination of pregnancy. 
A specimen obtained by the use of the catheter is 
the best for the purpose, if the patient be troubled 
by a discharge from the vagina. 

There is a natural increase in the amount of^ c o r ^ s t e o j. n 
urine passed by a pregnant woman, but the increase unne - 
is mainly in the water. Therefore the urine will 



Leucor- 

rhoea. 



36 OBSTETRICAL NURSING. 

be lighter colored than usual. The reaction of the 
urine should be acid. 

Should the reaction be alkaline, or the quantity 
of urine diminished rather than increased in amount, 
the fact should be reported to the patient's physi- 
cian. 

Leucorrhcea, a discharge from the vagina, com- 
monly known as " the whites," is much increased 
often during pregnancy, and is due to the greater 
activity in the secretion of all the mucous mem- 
branes. If a vaginal discharge be of a white, yellow, 
or green color, it indicates inflammation of the 
vagina itself. The discharge, on reaching the vulva 
and coming in contact with the air, decomposes and 
becomes irritating. Cleanliness is important in 
overcoming the effects of this. The itching induced 
by it is sometimes very obstinate, and generally 
worse at night. A solution of borax and water 
for bathing the parts, or carbolic acid, 15 to 201^ 
to a pint of water, will often give relief. Should 
vaginal injections be ordered by the physician, they 
should be given with great caution. A fountain 
syringe should be used, which produces a continu- 
ous stream. The interrupted stream should never 
be employed. In some conditions of excessive 
discharge the physician may prescribe tannic acid 
suppositories to be used nightly in the vagina. 
After a thorough drying of the parts surrounding 



MANAGEMENT OF PREGNANCY. 37 

the vulva, they may be dusted with a powder con- 
sisting of one part powdered camphor to four parts 
starch. This often gives great relief. Calomel 
powder may be used in the same way. 

Hemorrhoids, or piles, are often very trouble- ^idTor 
some during the latter part of pregnancy. Lying piles - 
down immediately after a movement of the bowels, 
and remaining in the recumbent position for ten to 
fifteen minutes, will tend to relieve them, also care 
in obtaining a daily evacuation of the bowels, and 
the use of means to secure as soft a movement as 
possible. Should the piles come down they should 
be fomented by cloths wrung out in hot water, to 
which a little Pond's Extract or fluid extract of 
hamamelis may be added — one tablespoonful, or 
two, to one pint of water — and when shrunken, 
anointed with cold cream or cosmoline and re- 
turned into the bowel. 

Sometimes the case is so aggravated as to neces- 
sitate keeping the patient in bed for a time. A 
physician should of course be consulted about the 
treatment. 

The swelling; and pain of the external organs of swelling ot 

x ° lower limbs. 

generation and of the lower limbs, resulting from 
pressure and the over-distention of the blood- 
vessels, is best relieved by the recumbent posture. 
Should the veins of the leg be much enlarged, 
or the feet swollen, the patient should have com- 



38 



OBSTETRICAL NURSING. 



pression made over them by the application of a 
bandage (the spiral-reverse of the lower limb), or 



Fig. 5. 







Spiral Reverse Bandage of Lower Extremity. 

she should wear an elastic stocking, such as may 
be obtained of any good instrument maker. For 



MANAGEMENT OF PREGNANCY. 39 

the bandage the best material is flannel cut bias, 
the width being about three inches. The bias 
bandage makes more even compression. Great 
harm may result from the neglect of enlarged 
veins, as they sometimes become so distended as 
to burst. Prof. T. S. K. Morton has devised a 
method of putting on a spiral bandage of the lower 
extremity, which retains its place better than that 
just described, which is apt to loosen when the 
patient moves about. Dr. Morton begins the 
application of his bandage as in the ordinary spiral 
reverse bandage of the lower limb, but carries 
oblique turns up and down the limb until its sur- 
face is entirely covered, in place of making reverses. 
When this bandage is further secured in place by 
carrying a running line of stitches up both the inner 
and outer side of the limb, it keeps its place per- 
fectly and is quite as serviceable as an elastic 
stocking. 

Pain caused by the stretching of the walls of the J. a i n f 5 om r 

«' o distention 01 

abdomen may be relieved by thorough inunction ^ b a d n ° s minal 
of the skin. Cotton-seed, olive or cocoanut oil 
may be used for the purpose. 

Severe pains in the back, neuralgic in character 
and so severe sometimes as to prevent the patient 
from sleeping, may yield to change of position, 
relieving pressure. Rubbing with soap liniment, 
volatile liniment, whiskey, or any liniment not too 



Pains in 
back. 



40 OBSTETRICAL NURSING. 

active, is helpful. Warm hip-baths may sometimes 
be prescribed by a physician. 

ictTvity e of The salivary glands are in some cases very active 

gland! 7 during pregnancy, inducing so excessive a secre- 
tion of saliva as to cause the patient great annoy- 
ance. This trouble is generally very intractable, 
and may refuse to yield to all treatment, ceasing 
only with parturition. Astringent washes, as of 
tannic acid, alum, myrrh, etc., may be tried, as also 
the use of pieces of ice. Physicians sometimes 
use atropia in small doses. Its use requires careful 
watching. 

Bad teeth. Bad teeth, which occur so often during preg- 
nancy, are said to be due to acidity of the saliva. 
A little baking soda or prepared chalk placed in 
the mouth at night will counteract the effect of this 

„.,,. acidity when it exists. The question is often asked 

Filling or J J- 

teSh^urin whether there is any danger in having the teeth 
pregnancy. fln ec j or attended to during pregnancy. There is 
always some danger, because a certain amount of 
nerve-irritation is the result. If the patient be 
suffering, however, it is better to have them filled 
by a temporary rubber filling, which causes little 
pain or irritation, than to lose rest in consequence 
of toothache. Extraction of the teeth should only 
be allowed when absolutely essential. If the pain 
be simply a neuralgic pain, it is better to wait. 
Vomiting is, as has been said in the- preceding 



MANAGEMENT OF PREGNANCY. 4 1 

chapter, a most common accompaniment of preg- vomiting of 
nancy. It more frequently exists, perhaps, with the 
first pregnancy than any other. The act is accom- 
plished, as a rule, without much effort. Diet seems 
to have but little effect upon it. Various articles 
have been recommended for it, as rice-water, beef- 
tea, barley-water, the various gruels ; the yolk of a 
hard-boiled cgg } scraped beef in the form of sand- 
wiches, ice-cream, cracked ice, etc. In some cases 
one or other of these seems to relieve the irritation. 
A cup of coffee, weak tea, or milk, taken warm early 
in the morning before the patient raises her head 
from the pillow, will often act as a preventive. In 
extreme cases of vomiting rectal feeding must be 
resorted to. In obstinate vomiting it is important 
that the physician should examine for the position 
of the uterus or the existence of ulcerations or 
erosions. 

It must not be forgotten that the constant loss of 
food may be so great a drain upon the patient's 
strength as to endanger her life. As this symptom 
is so largely sympathetic, the proper use of bro- 
mides or other nerve sedatives prescribed by a 
physician may be of great use in checking it. 

Care of the breasts in a pregnant woman neces- £ are ° f the 

r o breasts. 

sitates careful attention to the prevention of com- 
pression. Full development should be permitted 



42 



OBSTETRICAL NURSING. 



by the looseness of the clothing. The importance 
of the proper dressing of growing girls cannot be 
overestimated in this connection. Did mothers 
realize the evils — of which the atrophy of the breasts 
is but one — resulting from tight lacing, there would 
be fewer unhealthy women and fewer mothers 
unable to nurse their offspring. The nipples 
should be prevented from rubbing, and the skin 
over the nipples should be strengthened by using the 
Nipple bath, nipple-bath — filling a small, wide-mouthed bottle 
one-third full of cold water and inverting it over 
the nipples daily, from five to ten minutes at a time. 
Sometimes a little cologne-water or alcohol is added 
to the nipple-bath. Keeping ofif scabs and con- 
cretions of various kinds from the surface of the 
nipples by the use of a little oil is also admissible. 
The use of the nipple-protector, which will be 
referred to more fully in the chapter on the man- 
agement of the lying-in, is of great importance 
where there is a tendency to flattening of the 
nipple, to remove the pressure of the clothing. 

The clothing of a pregnant woman should be 
worn loose from the very beginning, both because 
the breasts begin to enlarge early and corsets inter- 
fere with their development, and because any 
amount of pressure upon the intestines tends to 
produce uterine displacements, which are especially 



Use of oil. 

Nipple 
protector. 



Clothing. 



MANAGEMENT OF PREGNANCY. 43 

dangerous during pregnancy, as they predispose to 
abortion. The clothing should all be supported 
from the shoulders. 

Many new dress reform systems are now in hygienic 

J J dressing. 

vogue, having for their object the great desideratum 
of adjusting woman's dress so as to make it both 
healthful and beautiful. Fortunately, in this enlight- 
ened age ideas of physical culture are so modifying 
old-time ideas of beauty that the wasp waist, the 



Fig. 6. 



Nipple Protector. 

multitudinous and voluminous skirts, the awkward 
and deforming bustle, the high-heeled boot, are fast 
becoming relics of the past. Among the dress- 
reform systems now in existence there is none so 
fully meets my views of healthful and beautiful 
dressing as the Jenness-Miller System. But few 
garments constitute the costume, and these are so 
constructed as to allow perfect freedom of every 
part of the body. 

A complete costume for summer wear, according 
to this system, would consist in the chemilette — a 



44 



OBSTETRICAL NURSING. 



combined"chemise and pair of drawers — around the 
waist of which buttons may be fastened, to which 
the second article of dress, the divided skirt or 



Fig. 7. 



Fig. 8. 





Jenness-Miller Divided Skirt. 



Jenness-Miller 
Chemilette. 



Turkish leglette, is buttoned. The latter is made 
so full that it takes the place of petticoats, and the 
dress may be comfortably worn over it. Should 
the dress be of some very sheer material, one addi- 



MANAGEMENT OF PREGNANCY. 



45 



tional muslin petticoat may be worn, similarly 
fastened to the waist of the chemilette. If a person 
is accustomed to wearing merino or silk underwear 
both summer and winter, the jersey-fitting union 



Fig. 9. 



Fig. 10. 





Union Undergarment. 



Jenness-Miller Leglette. 



under-garment may be worn beneath the chemilette, 
or, the latter being dispensed with, the Jenness- 
Miller " model bodice," or the Equipoise waist and 
divided skirt, may be worn alone over the union 
under-garment.* 

*The Delsarte waist, more recently devised, has a similar object, 
in meeting the hygienic and artistic requirements of woman's dress. 



46 OBSTETRICAL NURSING. 

For winter wear, plain leglettes of flannel, cash- 
mere or silk, or the same material as the dress, may 
be worn over the union under-garment and directly 
beneath the dress. Thus under-skirts are entirely 
dispensed with and all the clothing is supported 
from the shoulders. 

The skirts of winter dresses, being comparatively 
heavy, should be fastened to a waist of their own 
which has comfortably-cut armholes. 

Garters fastened to the waist are discountenanced, 
according to this system — as they should be, for 
they produce too much dragging on the waist, and 
the spiral-spring Duplex Ventilated garter is recom- 
mended to be worn until something better is de- 
vised. 

It is probable that the fashion will come into 
vogue of combining the stockings with the union 
under-garment, when garters will be done away 
with entirely. 

It is well for the stockings to be of wool or silk. 

The shoes or slippers worn should be comfortable 
and with broad soles and low hpels. 

Slender women can well wear the chemilettes, 
dispensing with all boned waists. Stout women, 
having busts, find more comfortable the model 
bodice, or the Equipoise waist,* which, I believe, is 

*This, wilh the other garments mentioned, may be obtained 
through the Dress Reform Emporiums in Philadelphia, or similar 
agencies in other cities. 



MANAGEMENT OF PREGNANCY. . 47 

not one of the garments of this system, but an 
exceedingly comfortable one, in my opinion. Mrs. 
Jenness-Miller is now devising some form of breast 
support which aims to support the weight of the 
breasts from the shoulders, so that waists contain- 
ing bones may not be regarded as a necessity, even 
by the stout. Both the " model bodice " and Equi- 



FlG. 




The Equipoise Waist. 

poise waist (the latter of which I prefer) contain 
bones, but dispense with the front steels, so injurious 
in the ordinary corset. 

For the changes in shape induced by advanced 
pregnancy the union under-garments will need to be 
of larger size than those ordinarily worn (about two 
sizes larger). Many beautiful designs for dresses 
and other outer-garments have been devised by Mrs. 



48 OBSTETRICAL NURSING. 

Miller, patterns for which may be obtained of the 
Jenness-Miller Co., in New York, or its agencies in 
other cities. Before leaving the subject I would 
mention, as one especially praiseworthy feature of 
this system, the perfect use of the arms permitted 
by the ingeniously devised patterns for sleeves and 
shoulder straps. If the skirts are not fastened to a 
properly constructed waist as described, they should 
be supported by suspenders. 

binden m When the abdominal walls are much relaxed, 

from stretching, allowing the womb to fall forward, 
it is well to use an abdominal binder or belt, especi- 
ally during the last month of pregnancy. This 
helps to keep the uterus in proper position. 

Fiannd Flannel should be worn — at least during preg- 

underwear. ° x ° 

nancy — both summer and winter. A lighter 
flannel can be substituted in summer for that which 
would be worn in winter. The use of flannel is to 
prevent chilling of the surface, and this is especi- 
ally important where — as in pregnancy — the kid- 
neys are overworked. It is important also for the 
condition of the heart and lungs. Coughs often 
cause premature labors. The jersey-fitting knit 
union under-garment, before referred to, may be 
obtained in all grades and sizes and is well suited 
to the purpose. 
Bathing. Bathing is very necessary for a patient during 

her pregnancy, as at other times. As regards the 



MANAGEMENT OF PREGNANCY. 49 

character of the bath, she can do as she has been 
accustomed to, using warm or cold water. A 
change from warm to cold water, or vice versa, is, 
however, not allowable. A sponge-bath, followed 
by brisk rubbing, is the most desirable. The skin 
is thus kept in good condition. Shower-baths 
should be avoided. 

Sea voyages are injurious, because of the danger voyages. 
of receiving falls or blows in consequence of the 
motion of the vessel, and also because of the lia- 
bility to sea-sickness induced by them. When it 
is absolutely necessary to take a sea voyage, there 
is probably least danger in the last three months of 
pregnancy, because the placenta, or afterbirth, is 
then well developed and its attachment to the 
uterus close. 

The regulation of the diet during pregnancy is ^egntnc^ 
of great importance. A patient should eat heartily 
for breakfast and dinner, but the evening meal 
should be light, especially from the seventh month 
on to the close of pregnancy. This meal should 
consist of stale bread, with butter and cooked fruit, 
as stewed apples, and a glass of milk or weak tea. 
Digestion is less active in the latter part of the 
day, and often a hearty meal may prove the direct 
exciting cause of convulsions. The food should 
be plain, wholesome, nourishing, well-cooked, and 
chosen in each case with special reference to the 
4 



50 OBSTETRICAL NURSING. 

avoidance of digestive disturbances and constipa- 
tion. Meat in moderate quantity, broths, milk, 
eggs, and fresh fruit should constitute an important 
part of the dietary. Pastry and confections should 
be avoided. 

Fruit diet. There is a mistaken theory prevalent in this day 
that a mother, by abstaining from certain kinds of 
food, as meat, eggs, milk, etc., and confining herself 
chiefly to a fruit diet, may thus, by preventing the 
hardening of the bones of the child, do away 
largely with the pains of labor. The truth of the 
matter is this: that during pregnancy all the func- 
tions of the mother's body are especially active in 
promoting the development of the child, hence an 
insufficient supply of essentially nourishing food 
will first affect the mother's system and render her 
unfit for the demands upon her strength at the 
time of parturition. 

Should a restriction to the fruit diet effect what 
it is claimed to do as regards the infant, it would 
result in the production of sickly, rachitic children, 
poorly developed mentally and physically. 

Exercise. Moderate exercise is essential during pregnancy. 

Walking on a level, not riding, is the best form of 
exercise. A daily walk should be taken, not, how- 
ever, after nightfall. The patient should avoid lift- 
ing — in fact, all straining movements — and most 



MANAGEMENT OF PREGNANCY. 5 I 

particularly should she avoid the use of the sewing- 
machine. 

There is sufficient proof that the mother's emo- Surround- 

ings. 

tions influence the child to render it important that 
her surroundings during pregnancy should be as 
pleasant as possible, and that she should avoid fright 
or any violent emotion. 



CHAPTER IV. 



ACCIDENTS OF PREGNANCY. 



Hemor- 
rhage. 



Recumbent 
position. 

Note to 
physician. 



Preserva- 
tion of 
discharges. 



A discharge of blood from the womb, known as 
" uterine hemorrhage," may occur at any time dur- 
ing the pregnancy, and is usually a sign that the 
patient is threatened with a miscarriage. However 
slight the flow, the nurse should have the patient 
lie down until the doctor has been told of its occur- 
rence, and decides what the patient should do. A 
note should be sent to the doctor, telling just what 
has happened, and clearly making him understand 
the urgency of the symptoms — that is, the amount 
and character of the flow — and the condition of the 
patient. A nurse should not trust to a verbal mes- 
sage, as the physician may fail to respond to the 
call promptly, not being aware of the urgency of 
the symptoms. The patient should be required to 
use the bed pan, or, at least, a vessel the contents 
of which can be thoroughly examined, both for the 
bowels and the passage of urine. All discharges, 
soiled clothing, clots, etc., should be carefully saved 
for the inspection of the physician. 

52 



ACCIDENTS OF PREGNANCY. 53 

Meantime, an effort should be made on the part Efforts of 
of the nurse to control the flow. The patient should control flow, 
lie with her head low, and a pillow under her hips ; 
she should not be warmly covered, plenty of cool, 
fresh air should be admitted into the room, and she 
should be kept excedingly quiet. 

Should the symptoms become more urgent, the Toprevent 
patient being threatened with fainting, the head may faintin s- 
be lowered by raising the foot of the bed, placing 
bricks or chairs under it in such a way as to make 
a decided inclined plane of the bed. The patient 
should be fanned, given hartshorne to inhale, and 
her limbs rubbed, to keep them warm, with alcohol 
or whiskey. Small doses of whiskey or aromatic 
spirits of ammonia may be given her in cold water, 
if able to swallow, or black coffee, or tea, not too 
warm. If there is much blood flowing from the 
vulva, vaginal injections of hot water, at a tempera- Actions. 
ture of about no° to 115 , may be kept up until 
the flow ceases. 

Alarming hemorrhages are often the result of Causes of 

hemor- 

accidents, falls, or blows, or they may be caused by rha ges . 
heavy lifting. 

Hemorrhage from a low attachment of the pla- Unavoidable 
centa, or afterbirth, or when the afterbirth occupies ^^" 
an unusual position — that is, at the side of or over 
the mouth of the womb — occurs without any history 
of accident. It takes place at any time from the 



54 



OBSTETRICAL NURSING. 



Hemor- 
rhage from 
rupture of 
varicose 
vein. 



Miscar- 
riages. 



Prevention 
of mis- 
carriages. 



Precaution 
during men- 
struation. 



seventh month of pregnancy on to its termination, 
and without any premonitions of its coming. It may 
occur at night while a patient is lying in bed. The 
management of this condition would be the same 
as that described above, until the doctor comes. 

Women suffering from enlarged, swollen veins, 
" varicose veins," or " varices," of the lower extremi- 
ties, if not careful in keeping the limbs bandaged 
or supported by elastic stockings, may have hemor- 
rhage occur by the bursting of one of these over- 
distended veins. The amount of blood lost may 
be so great as to imperil the patient's life. Should 
such a rupture of a vessel occur, compression 
should be made just below the point of rupture, to 
control the bleeding, until the physician, who 
should have been sent for, arrives, when he will 
resort to the measures necessary for securing 
against further hemorrhage. 

Miscarriages are apt to recur, hence a patient 
who has once suffered from one, should be cau- 
tioned to take additional care of herself during any 
subsequent pregnancy. Any sensation of weight 
about the hips, with the recurrence of a " show," 
or slight discharge of blood, and cramp-like pains 
should warn her to lie down and send for her phy- 
sician. Such a patient should also take the precau- 
tion to lie down as much as possible (if not in bed, 
on a lounge) during the time when, under other 






ACCIDENTS OF PREGNANCY. 55 

circumstances, she would have her monthly flow. 
Any patient having had a number of miscarriages 
should keep herself under the care of her physician 
from a very early date in the pregnancy, being 
placed under a regular course of treatment. 

It is well, in this connection, to speak of the im- After . treat . 
portance of care in the after-treatment of miscar- ™rrilgL mis ~ 
riages. Not uncommonly, patients, especially of 
the working classes,- get up and go about their 
work a day or two after the occurrence. This is a 
dangerous proceeding, for, though the ill-effects 
may not be felt for a time, chronic disease of the 
uterus is apt to result. If the pregnancy terminates 
before the fourth month it is commonly called an 
abortion. Between the fourth and seventh month 
it is a miscarriage, and after the seventh month, if 
before term, a premature labor. 

It is really necessary to give more time to the Confinement 
recovery from the effects of an abortion, than to t0 
recovery from a confinement at term, and the pa- 
tient should be willing to remain in bed at least a 
week or ten days, or longer, if thought best by her 
physician. The patient should not leave her bed 
so long as any discharge of blood continues. 

Premature rupture of the membranes enclosing premature 
the child, with a discharge of colorless liquid, com- membranes. 
monly known as " breaking of the waters/' is another 
of the accidents of pregnancy, and is invariably 



56 OBSTETRICAL NURSING. 

followed, within a few days, at least, by the expul- 
sion of the child. The patient will complain of her 
clothing becoming wet, either by a sudden dis- 
charge of a quantity of liquid, or by a slow but 
continuous flow. The nurse can assure herself 
that this liquid is not urine by her sense of smell. 
The smell of urine is characteristic. With the 
amniotic liquid surrounding the child, there is 
almost an entire absence of smell, a peculiar, faint, 
musty odor being alone recognizable. 
Saving It is best, in removing this wet clothing from the 

clothing for . . , . 

inspection, patient, to set it away, that the physician may judge 
for himself of the character of the liquid. The pa- 
tient should at once lie down, not taking the erect 
position for any cause, not even for defecation and 
urination, and the physician should be sent for, with 
a written statement as to what has occurred. It is 
important that the physician should see the patient 
as soon after the rupture of the membranes as 
possible, because the sudden loss of water may have 
brought about changes in the position of the child 
which may endanger its life. The loss of the entire 
amount of liquid contained in the sac would cause 
also difficulties in the delivery, or what is known as 

Dry labor. " 3. diy labor." 

Convui- Convulsions may sometimes occur during the 

sions. 

pregnancy. The symptoms which threaten this 
trouble are extreme restlessness and uneasiness 



ACCIDENTS OF PREGNANCY. 57 

on the part of the patient ; severe headache, often 
confined to one side of the head; disorders of vision, 
as seeing things double, or seeing but the part of 
an object, sometimes very imperfect vision, and 
occasionally absolute loss of sight ; twitchings of 
the muscles, especially of the face, may occur. The 
convulsion is ushered in by this restlessness and 
twitchings, beginning first about the eyes and ex- 
tending rapidly to the mouth, arms, and lower 
extremities. The movements are not violent, hence 
the patient is not likely to throw herself out of bed. 
The physician should be sent for; meantime, the 
nurse should see that the patient is kept lying down, 
that her clothing is well loosened, especially about 
the head and chest, that plenty of fresh air enters 
the room, and that the patient is kept from biting 
her tongue. A folded handkerchief or towel 
slipped in between the teeth pushes back the 
tongue and prevents the teeth from coming down 
upon it. 

The patient's feet should be kept warm and head 
cool. The members of the family must be kept 
calm and prevented from meddlesome interference, 
for the attempt to make the patient swallow any 
stimulant while struggling and unconscious may 
result very disastrously. Should the attending 
physician live too far away or be delayed in coming, 
the nearest physician Should be sent for. 



CHAPTER V. 

GERMS AND ANTISEPSIS. 

One of the most important things for an obstetric 
nurse to know is the meaning of the term " anti- 
Antisepsis, sepsis," and the method by which antisepsis may 
be carried out in her work. 

Literally, the term " antisepsis " means "against 
sepsis or putrefaction," and refers to the application 
of means by which objects may be rendered en- 
tirely free of all poisonous elements. 
Germs Dust, as we know, is everywhere present in the 

wherefound - atmosphere, and consequently settles upon every- 
thing exposed to it. This dust consists, as has 
been found, of very minute organisms, which, when 
they are planted in a suitable soil, grow and multi- 
ply very rapidly, producing, as a result of their 
activity, the poisonous fluids and gases which 
characterize the process of putrefaction, 
ptomaines. These products are called ptomaines. The sub- 
stances thus formed, when absorbed into the blood, 
give rise to the symptoms of blood-poisoning. It 
may, therefore, be plainly seen that the simple 

58 



GERMS AND ANTISEPSIS. 59 

neglect of measures to destroy these dust germs 
may, by allowing decomposition of the natural 
discharges, lead to septic poisoning. 

It has been found, as a matter of experience, that Poisonous 

x properties. 

other diseases besides those commonly classed 
under the head of " child-bed fever," or " puerperal 
sepsis," may be induced by these small germs, and 
this explains why it is so very important that ery- 
sipelas, scarlet fever, or other acute contagious 
diseases should be avoided by those engaged in 
obstetric practice. A nurse leaving such a case to 
go to a confinement case will do so at the risk of 
her patient's life, for puerperal fever will almost 
certainly be induced by the germs which she carries 
from the former case. 

The minute bodies known as germs are, we see, ciassifi- 
greatly to be dreaded. They are of three kinds — germs. 
first, those to whose action most of the infective 
diseases are attributed, and which are divided, 
according to their shape, into micrococci, round- 
shaped bodies; bacteria, oval-shaped bodies; bacilli, 
rod-shaped bodies of varying length ; and spirillse, 
or spiral, thread-like bodies ; second, yeasts ; third, 
moulds. 

To give an idea of their size, it has been said of size, 
one of the most common forms of germs (the rod- 
like), were fifteen hundred of them put end to end 



6o 



OBSTETRICAL NURSING. 



Growth. 



Conditions 
of growth. 



Method of 
growth. 



they would scarcely reach across the head of an 
ordinary pin. 

Their rate of growth, too, is very rapid, a com- 
mon estimate being that they double themselves 
once or twice every hour. Thus, in the course of 
twenty-four hours a solitary germ may become a 
colony of between sixteen and seventeen millions. 

Warmth, moisture, and a certain amount of 
organic matter are the conditions which favor their 
development. Most, but by no means all, forms of 
bacteria require air ; some, however, can only 
develop in the absence of air. 

Germs may grow by division ; that is, one of 
them may have a constriction form about its middle 
which finally becomes a complete partition, so that 
two distinct germs are thus formed. These simi- 
larly divide, and thus their number multiplies. 
Another method of growth is by spore formation. 
At one or more points in a rod an oval spot appears 
which becomes brighter and clearer. These spots 
are spores, and when fully developed they become 
free, the rest of the rod dissolving away. These 
spores retain their vitality for years, ready at any 
moment when suitable conditions are provided to 
develop into fully formed germs. It is extremely 
difficult to destroy the vitality of these spores. 
Many antiseptics which readily kill the adult germs 



GERMS AND ANTISEPSIS. 6l 

will not harm the spores — or only do so after a 
much longer time than that necessary for the adult 
germ. 

Even where the antiseptics do not kill, however, 
they may retard the development of these germs 
and thus prevent their doing injury. 

In all germ diseases a battle is fought between 
the patient's body and the germs with which it is 
infected. If the germs are present in small quantity 
only, it is possible the resisting power of the body 
may enable them to be overcome. 

If, however, the general health is impaired by conditions 

r • r i • i favoring 

overwork, deficient food, overcrowding, or other sepsis, 
depressing influences, the patient w T iil be more 
likely to succumb to the attack. This explains 
why some patients escape under the same condi- 
tions in which others suffer from blood-poisoning. 

Lying-in patients are especially liable to germ Proclivity 
infection, both because the labor leaves them in a during 

r 11 i lying-in. 

state of exhaustion and because there are always 
certain open surfaces present upon or within such 
a patient's body — so that these serve as direct 
avenues for the entrance of poison into the system. 
The site within the uterus from which the placenta 
or after-birth is detached is one of these ; others 
being the fissures or lacerations about the neck of 
the uterus, the vagina, or perineum. This shows 



62 OBSTETRICAL NURSING. 

the importance of protecting from decomposing 
discharges all such open surfaces. 

Experiment has shown that bruised tissues are 
especially liable to destructive inflammation from 
the action of germs. This explains why first labors 
and difficult and tedious labors are most apt to be 
followed by septic infection. 

Should such a labor be followed by the occur- 
rence of sloughing wounds, it is therefore especially 
important that any discharges from the wound 
should not be retained, but kept carefully removed 
by means of antiseptic irrigation, etc. Care should 
be taken that the antiseptics used should not be in 
sufficient strength, however, to irritate the wound, 
as this may increase the trouble. 

Any condition such as an attack of inflamma- 
tion, exposure to cold, or disordered digestion, 
because it lowers the vitality of the body, tends to 
increase the tendency to septic infection. 

Besides the diseases resulting from the classes 
yea"t-hrf££ °f germs most commonly concerned in the pro- 
duction of putrefactive changes in the body, we 
have some which are due to " mould-infection " and 
the action of yeasts — which are also lowly organ- 
isms existing in great numbers in the atmosphere, 
and capable of setting up destructive changes in 
tissues. It is the "moulds" which are the cause 



Diseases 
due to 

mould- and 

yeas 

tion 



GERMS AND ANTISEPSIS. 63 

of food spoiling when allowed to stand exposed to 
the air. The disease known as " thrush," which is 
characterized by grayish patches forming upon the 
mucous membrane of the mouth and adjacent 
parts, is due to a parasite which is one of the 
" yeasts." A number of skin diseases are caused 
by the growth of " moulds." 

In order to prove the fact that animal fluids will Ex P eri .- 

1 ments in 

not undergo putrefaction if germs are excluded ^ a o cteri- 
from them, a series of very interesting experi- 
ments were made for a class in one of the London 
hospitals recently, to illustrate some of the most 
common errors in nursing. These can be repeated 
for class instruction anywhere. 

A series of glass tubes were taken, into which 
some sterilized beef-tea or beef-jelly was introduced. 
Into two of these tubes scrapings from under the 
finger-nails were placed, and in one the little specks shapings 

* ' L from finger 

were soon seen to eat their way into the jelly, nails - 
followed by a trail of microbes. In the other 
tube a dense mass of moulds developed, and the 
beef-jelly was transformed into a dark brown 
color. 

Into a third tube apiece of cotton used in wiping Discharge 

r r from vulva. 

the vulva of a lying-in woman, previous to passing 
the catheter, was dropped, with the result of show- 
ing almost immediately a mass of germs which 
descended into the jelly, liquefying it by their pres- 



64 OBSTETRICAL NURSING. 

ence, while the cotton, owing to the air it contained, 
floated on the surface. 

A drop or two of urine from the bladder of a 
Urine in patient suffering from inflammation which had 

case ot x ° 

cystitis. resulted from the use of an impure catheter, was 
introduced into a fourth tube containing the steril- 
ized beef-jelly. This caused the jelly from above 
downward to be converted into a dirty-looking 
yellow fluid, whilst a whitish mass of germs 
accumulated on the surface of the jelly. 

The importance of antiseptic precautions in the 
nursing of infants was well illustrated by two other 
experiments. Into a tube containing some of the 

Sour milk, sterilized beef-jelly a drop of sour milk was placed ; 
very rapidly a mouldy coating appeared over the 
surface of the jelly. When we think of a similar 
process taking place in the digestive tract of an 
infant, we can realize why babies should suffer so 
greatly from careless management of their food. 

scrapings Another tube had introduced into it some scrap- 

from 

"thrush." ings from the mouth of a child suffering with 
"thrush." Colonies of snowy-white germs ap- 
peared which, as they grew larger, became of a 
greenish color and spread with great rapidity. 

As object lessons serve to impress the import- 
ance of facts, these experiments serve to keep before 
us the importance of antiseptic precautions in the 
care of mother and child. 



CHAPTER VI. 

APPLICATION OF ANTISEPSIS TO CONFINEMENT 

NURSING. 

The use of antiseptics has almost entirely anni- Antiseptic 
hilated puerperal fever, commonly known as ''child- 
bed" fever. This disease, as we know, is simply 
blood-poisoning or septicaemia, and is caused by 
the entrance through a wound of some poisonous 
material into the blood. In the simplest and most 
natural labors slight tears are apt to exist either 
about the external parts or about the neck of the 
uterus. There is always a wound inside of the 
uterus at the place where the placenta or after-birth 
was attached. In difficult labors there may be 
extensive wounds. 

Septicaemia, or blood-poisoning, may be caused Causes of 
■ . . biood- 

by a piece of placenta or blood-clot being retained poisoning. 

in the uterus or birth canal after the delivery, and 

there putrefying. It may also be caused by the 

patient's attendants having some poisonous material 

on their hands, instruments, or various appliances, 

and bringing these in contact with her wounds. 

5 65 



Preventive 
measures. 



66 OBSTETRICAL NURSING. 

Dirty hands, dirty finger-nails, unclean bed-pans, 
soiled clothing, etc., may be the cause of the 
trouble. Sponges should never be used in the 
lying-in room. Artificial sponges made of anti- 
septic cotton enclosed in gauze may be substituted. 
The poisonous material which might be thus con- 
veyed to the wounds of the lying-in woman must 
be guarded against by the most scrupulous attention 
to thorough cleanliness. 

Antiseptics are chemical substances which have 
the power of destroying the germs of putrefactive 
change or rendering them inert. They should, 
therefore, be systematically used in all cases of 
labor to prevent septic germs from entering the 
wounds and giving rise to puerperal fever. The 
antiseptics most generally employed in the mater- 
nity wards of the Woman's Hospital are carbolic 
acid, corrosive sublimate, permanganate of potas- 
sium, iodoform, chlorinated lime, boracic acid, 
salicylic acid, oxalic acid, and tincture of iodine, 
according to the purpose for which each is designed. 

Solutions of corrosive sublimate should not be 
put into a metal dish, as the metal is thus corroded. 
The strength of all antiseptics is impaired by ad- 
mixture with soap, so that one should not wash 
with soap in an antiseptic fluid. 

The following rules, indicating the antiseptic 
precautions observed in the maternity wards of the 



ANTISEPSIS IN CONFINEMENT NURSING. 6 1 / 

Woman's Hospital, will illustrate the precautions to 
be observed in all confinement nursing : — 

RULES TO BE OBSERVED BY NURSES.* 

1. The nurses on duty in the maternity wards isolation, 
shall have no communication v/ith the general 
wards of the Hospital. They shall be transferred 

to separate dormitories from those occupied by 
nurses on duty in the general wards. They shall 
give especial attention to personal cleanliness. 

2. They shall not touch the genital organs of 

a patient without having first thoroughly disin- Disinfection 
fected their hands. If their hands have come in ° 
contact with any foul discharges, this cleansing 
shall be accomplished as follows : 1st. Thoroughly 
wash the hands with soap and water, scrubbing 
them well with a clean nail brush. 2d. Wash the 
hands in a saturated solution of permanganate of 
potassium, which colors them brown. 3d. Bleach 
the hands by washing them in a saturated solution 
of oxalic acid. 4th. Rinse them thoroughly clean 
in boiled, filtered water; and, 5th, Dip them for a 
few moments in a solution of bichloride of mercury 
(corrosive sublimate), of the strength of from 
1-1000 to 1-4000, or a solution of carbolic acid 



* Rules for preparation of the patient for labor are given else- 
where. 



68 



OBSTETRICAL NURSING. 



Antiseptic 
dressings. 



two per cent. The washing with permanganate of 
potassium and oxalic acid solution may be omitted 
where foul discharges have not been handled. 

3. Bottles containing solutions of corrosive sub- 
limate 1- 1 000, and carbolic acid 1-40, shall be 
placed on the wash-stand in every ward and de- 
livery room. The solutions of permanganate of 
potassium and oxalic acid shall be kept ready for 
use in the bath rooms. A small jar of carbolized 
vaseline shall be kept in each room. 

4. The dressings removed from a patient shall 
at once be carried out of the room and burned in 
the furnace. 

5. Immediately before the application of a fresh 
dressing the nurse shall irrigate the external geni- 
talia with either a corrosive sublimate solution 
1-4000, or carbolic 1-40; dry the parts with a 
piece of antiseptic lint, and then apply the occlu- 
sion dressing. (Directions for preparation of anti- 
septic dressings are given elsewhere.) 

6. If the patient be a primipara (a patient with 
her first child), an iodoform suppository (30 grs.) 
shall be introduced into the vagina for a week, once 
daily. 

Catheters 7. Metal and glass catheters shall be cleansed 

vaginal ° 

nozzles, etc. after each use by boiling, and kept in the intervals 



of use in a solution of carbolic acid 1-40. 
Vaginal nozzles shall be similarly treated, 



Each 



ANTISEPSIS IN CONFINEMENT NURSING. 69 

patient shall have a separate vaginal nozzle for her 
exclusive use. 

Soft rubber catheters, after a thorough cleansing 
with soap and water, shall be kept in a solution of 
corrosive sublimate i-iooo. 

Before using the catheter the nurse shall anoint 
it with a little carbolized vaseline. 

8. Syringes shall be cleansed after each use, by Syringes. 
having an antiseptic solution pumped through 
them. No vaginal injections shall be given during 

the lying-in, except after a direct order from the 
physician. 

9. If vaginal injections are required to be given Vaginal 

injections. 

when there is much fetid discharge from the vagina, 
an injection of permanganate of potassium (a sat. 
solution) may be given in preference to the ordinary 
solution of 1-4000 corrosive sublimate or 1-40 
carbolic acid. The nurse should always carefully 
report the occurrence of any odor in the discharge. 

10. All rubber sheets used about the patients' Rubber 

sheets. 

beds shall be washed in a solution of corrosive 
sublimate 1-1000 or carbolic acid 1-20. 

11. All clothing removed from patients or their soiled cloth, 
beds, soiled with discharges, shall be at once taken 

to the soak-tubs at the wash-house. When the 
blood has been soaked out in cold water they shall 
be placed in a disinfectant solution of carbolic acid 



70 OBSTETRICAL NURSING. 

1-20, for an hour, and then put through the ordinary 
processes of the wash. 

All soiled clothing shall be at once removed from 
patients' rooms. 

Deaths. 12. On the death of any patient in the maternity 

the body shall be at once wrapped in a bichloride 
sheet (i-iooo) and removed to the mortuary. 

visitors. 13. No one shall be allowed to visit the Hospital 

who is engaged in the dissecting rooms, or attending 
post-mortem examinations, or doing work in opera- 
tive surgery upon the cadaver. No one attending 
infectious cases shall be admitted to the lying-in 
wards. 

No visitors shall be admitted to see patients in 
the maternity unless provided with a special pass 
from the physician in charge. 

Disinfection 1 4. Each room vacated by a patient shall be 

of rooms. . 

fumigated with sulphur before it is again occupied. 

The straw contained in the mattress upon which 
she lay shall be burned and the ticking boiled and 
then refilled with fresh straw for the next case. 

The bed, stands, etc., shall be wiped off with a 
solution of corrosive sublimate or carbolic acid 
when the room is reopened after fumigation. 
Precautions jc The mother's nipple and the baby's mouth 

in nursing. J rr J 

shall be washed with a solution of boracic acid 
before and after each nursing. 



ANTISEPSIS IN CONFINEMENT NURSING. 7 1 

16. The baby's cord shall be kept dressed with a The dress- 
powder containing salicylic acid, I part, to starch, 5 cord. 
parts, which shall be changed as often as necessary. 

17. Immediately after delivery the baby's eyes Baby's eyes. 
shall be washed with a saturated solution of boracic 

acid or one of nitrate of silver (1 gr. to the ounce) 
as directed. 

Every nurse should know how to watch for Thes y m P- 

y toms of 

symptoms which may indicate that there is an]? oison [ n g 

J *■ J trom the use 

undue absorption of the antiseptic employed taking ° f c * ntisep " 
place. 

As to the selection of the antiseptic employed, 
the choice will be dependent upon the physician. 
If the nurse is obliged to depend upon herself, 
certain points must be taken into consideration. 
Thus she must remember that patients with kidney 
disease are especially susceptible to poisoning from 
the effect of corrosive sublimate. Ansemic or 
bloodless patients bear both carbolic acid and cor- 
rosive sublimate badly. Children are particularly 
susceptible to carbolic acid. 

The poisoning from antiseptic agents in confine- 
ment nursing most frequently occurs from the use 
of the antiseptic agent in the vaginal douche. 

It is not unusual, when carbolic acid has been Car boiic 
employed for some time, to find the urine of a darkfng. po1 
greenish color ; also to find that it contains albu- symptoms 

and treat- 
men. One or more of the following symptoms ment. 



72 OBSTETRICAL NURSING. 

may also be present: sickness or nausea, increased 
flow of saliva, difficulty in breathing, an anxious 
expression, sometimes fever, and always great 
weakness. 

Should any of these symptoms arise, the doctor 
should be at once notified. The patient may be 
stimulated b}^ repeated small doses of brandy, and 
external friction should be employed. 

If carbolic acid has been swallowed, the first 
thing to do is to get rid of the poison by the ad- 
ministration of an emetic, as by copious draughts 
of mustard and water or salt and water; or the 
stomach should be washed out with the stomach- 
pump. The easiest and one of the best things to 
use after this would be sweet oil or cotton-seed oil 
in large quantities. The patient's body must be 
kept very warm by hot blankets and rectal enemata 
of beef-tea, or milk and whisky used. 
Corrosive The mouth and bowels are most apt to be first 

sublimate 

poisoning, affected by the absorption of corrosive sublimate. 
Any tenderness or sponginess of the gums must be 
noticed, or increase in the amount of saliva. Loose- 
ness of the bowels also requires the immediate 
discontinuance of the drug. Headache, dizziness, 
pains in the abdomen, lowering of temperature, 
sweats, and general prostration, with albuminous 
and sometimes bloody urine, are other symptoms 
which may arise from the same cause. 



ANTISEPSIS IN CONFINEMENT NURSING. 73 

The drug must be stopped at once, the abdominal 
pain relieved by the use of poultices, a soothing 
diet of rice-milk or arrow-root, etc., employed, and 
such medicines given as the doctor may direct. 

If the drug is swallowed by mistake, the same 
treatment would have to be followed as in the case 
of carbolic acid poisoning, except that it is best at 
once to administer the whites of two or three eggs 
to form an insoluble albuminate of mercury in the 
stomach, so that it may not be readily absorbed but 
brought up by the use of a subsequent emetic. 

In mild cases, sleeplessness, headache, loss of 
memory, are the main symptoms, but in severe 
cases mania, melancholia, or hallucinations may T J , 

' J Iodoform 

develop from iodoform poisoning. Sometimes P° isonin s- 
there is considerable rise of temperature. The 
withdrawal of the drug and the support of the 
patient's strength constitute the main line of treat- 
ment. Sometimes the use of about ten grains of 
cream of tartar, every hour for a time, has been 
found of advantage. 

Permanganate of potassium, boracic acid, and Permangan- 

...... r . ate of potas- 

sahcylic acid are harmless, so far as toxic effects are smm, bor- 
acic acid, 

concerned, but have not the same power. salicylic 

1 r acid. 

Chloride of lime and chlorinated soda are of chloride of 
value as antiseptics because of the chlorine which chlorinated 
is set free in their solutions. A small quantity, as sc 
from a half to one drachm of the powdered chlo- 



74 OBSTETRICAL NURSING. 

ride of lime, may be dissolved in a pint or more of 
water. 

The chlorinated soda is found in a preparation 
known as Labarraque's solution, of which a tea- 
spoonful to a pint of water makes a solution strong 
enough for a vaginal injection. If to each ounce of 
this solution about four grains of permanganate of 
potash is added, the value of the solution as an 
antiseptic agent is greatly increased. 

Condy's fluid contains, as its active ingredient, 
permanganate of potash, about eight grains to the 
ounce of water. A teaspoonful of Condy's fluid 
to the pint of water makes a solution suitable for a 
vaginal injection. 

It is not likely that poisoning would occur from 
the use of any of these agents. 

Permanganate of potassium and Condy's, fluid 
are objectionable because of the brown stain they 
produce when dropped on clothing.* 
ifaToom 1 . 011 Rooms are generally disinfected, as after cases 

* Lysol is a coal-tar product now largely used as a disinfectant 
in several surgical and lying-in clinics in Germany. It is claimed 
to be superior to carbolic acid, creolin and other preparations of the 
same kind in its germicidal action, and it possesses powerful 
deodorizing properties. It is perfectly soluble in water, and its 
solutions are soapy in character, removing all dirt (fatty or resinous 
spots, etc.), which does away with the necessity for soap in cleans- 
ing. It is used in ^, I, and 2 per cent, solutions in midwifery and 
surgery. 



Disinfect! 



ANTISEPSIS IN CONFINEMENT NURSING. 75 

of septicaemia, etc., by burning sulphur in the pro- 
portion of at least three pounds for every thousand 
cubic feet of air space. To secure any good re- 
sults, close the apartment as closely as possible 
by stopping up all apertures through which the 
gas might escape, by means of wet rags, which 
may be stuffed into the cracks around doors, win- 
dows, etc. The sulphur is put into a deep tin pan, 
which is placed upon two bricks, in a tub partly 
filled with water, in the middle of the room. A 
little alcohol may be poured on the sulphur, which is 
then set on fire, or a few live coals placed in the pan. 
The fumes should be kept in the apartment from 
twelve to twenty-four hours, after which doors and 
windows should be thrown open, and it should be 
subjected to free ventilation. All surfaces in the 
room must be then washed off with a carbolic 
solution (2 per cent.), or corrosive sublimate 

I-IOOO. 

Infected underclothing, bedding, etc., are best underdoth- 
destroyed by fire, if of little value. To disinfect Sc! 
them we may employ — 

(a) Boiling for at least a half hour. 

(p) Immersion in corrosive sublimate, sol. 1-1000, 
for three or four hours. 

(c) Immersion in a 5 per cent, carbolic sol. 

To avoid the discoloring effects of these solu- 
tions, clothing taken from them should be thor- 



7 6 



OBSTETRICAL NURSING. 



Outer 
garments. 



Mattresses 

and 

blankets. 



Water- 
closets, etc. 



oughly rinsed out in clear water before it is sent to 
the laundry. 

Outer garments which would be injured by 
boiling water or a disinfecting solution, may be 
sterilized — 

(a) By exposure to dry heat at a temperature of 
230 F. (no° C). 

(J?) By the steaming process in a suitable appara- 
tus. 

Mattresses and blankets should be disinfected 
in the same way. If these means are not available, 
mattresses may have their covering removed, and 
washed and boiled separately, the contents being 
immersed in boiling water for a half hour. 

Solutions of copperas (sulphate of iron) or green 
vitriol, in the proportion of 1^ pounds to a gallon 
of water, are good and also very cheap. 

Slaked lime and chloride of lime may be used 
for privy vaults. 

Solutions of the chloride of lime may be used 
also in water-closets, but there is danger of chok- 
ing up the pipes if the solutions contain consider- 
able deposit. Carbolic acid solutions, 5 per cent., 
or bichloride 1-1000 may be used instead of the 
above. 



CHAPTER VII. 
PREPARATIONS FOR THE LABOR. 

The relations between nurse and patient begin 
from the time the engagement is made for a nurse's 
attendance upon the confinement. 

The nurse is generally consulted beforehand as Advice to 

° J patient. 

to the articles that will be needed at the time of 
the confinement and for the baby's outfit. Also, 
she is sometimes asked concerning the choice of a 
room for the labor and lying-in. 

The room is a most important consideration. It choice of 

x room. 

should be light, having the free entrance of sun- 
light ; quiet and well ventilated. It should not be 
too near a water-closet; in fact, it is far better to 
have the water-closet out of the house entirely; 
There should be no stationary washstand in the 
confinement room ; or, if this cannot be avoided, 
the connection with the sewer pipe should be cut 
off, or the holes and escape pipe in the basin 
plugged up, the basin being kept filled with fresh 
water frequently changed. No slop jar or any 
vessel containing wash water, discharges, etc., 

77 



y8 OBSTETRICAL NURSING. 

should be allowed in the room. An ounce of 
prevention, in the way of keeping jdisease germs 
out of the room, is worth more than a pound of 
cure. 

Mother's As re g arc [ s the mother's dress, she should be 

advised to have a sufficient number of good-sized 
merino or flannel vests, to be able to change night 
and morning, so that the same vest shall not be 
worn both day and night. These are more readily 
changed if opened all the way down the front and 
fastened with tapes. The free action of the skin 
after delivery necessitates the use of flannel or 
merino to prevent chilling. If a long night-dress 
is worn, there is no necessity for the chemise. The 
night-dress, also, should be opened all the way 
down the front, as it renders easier for the patient 
the frequent changes which are necessary. Suf- 
ficient night-dresses and vests should be provided 
to make it possible for the clothing to be changed 
every day. 

Abdominal Two or three abdominal bandages, also, should 

bandages. . . ^ _ ., . 

be provided, either fitted to the patients person or 
straight. If fitted, the bandages should be pre- 
pared when the patient is about six months preg- 
nant, to be the right size after delivery. The 
bandages should extend from the pubic bone (the 
bone just above the external generative organs) to 
the breast bone, being about a half-yard wide and 



PREPARATIONS FOR THE LABOR. 



79 



long enough to go once around the body and 
overlap one-third. "It is best made of soft muslin 
doubled, the seams being turned in at the edges. 
Large safety-pins should be provided for fastening 
this bandage down the front. 

Where the breasts are large and pendulous, some ^east es 
bandage may be required for their support. An 
abdominal bandage may be used for this purpose, 
though it is rather wider than is necessary. 



Fig. 12. 




Occlusion Dressing (Dr. Garrigues). 



When the physician does not require the anti- 
septic dressings, now almost universally used, at 
least two dozen napkins of diaper linen should be Napkins. 
provided for the mother, as very frequent changes 
of the napkin are essential during the first few days 
after the delivery, while the discharges are free. 

The antiseptic dressings used in the Woman's^ 1 ^ 
Hospital, of Philadelphia,. are essentially the same 



80 OBSTETRICAL NURSING. 

as those recommended by Dr. Garrigues, of New 
York, known as the occlusion dressing. They con- 
sist of a piece of dry patent lint, 6X8 inches, which 
has previously been rendered antiseptic by satura- 
tion in a solution of bichloride of mercury 1-1000. 
This is placed, doubled in its width, so as to make 
a dressing, 3X8 inches, directly over the external 
organs of generation. This lint is covered by a 
piece of gutta-percha tissue, 4X9 inches, which is 
wet in a 1-4000 solution of bichloride of mercury. 

Perineal These dressings are kept in place by a napkin of 

sublimated cheese cloth, 18 inches square, folded to 
form a diagonal, 5 inches in width, within whose 
folds a pad of oakum is enclosed. The napkin is 
tightly fastened to the abdominal bandage, both 
anteriorly and posteriorly, by means of safety-pins, 
and the access of air to the vagina is thus pre- 
vented. These dressings are changed at least once 
in three hours, the dressing removed being at once 
burned. It is seldom necessary to continue the 
dressings longer than two weeks. They should be 
kept up, however, so long as the discharge persists. 

Quantity After the above statement, it will be seen that 

needed. 

a nurse should have the patient obtain of each of 
the articles comprising the dressing the following 
quantity: Cheese cloth, 12 yards; gutta-percha 
tissue, 1 yard ; patent lint, 2 yards ; oakum, ]/ 2 to 
1 pound. 



PREPARATIONS FOR THE LABOR. 



8l 



The cheese cloth may be obtained at any dry- ^^ e ed 
goods store, and prepared by first thoroughly 
washing with soft-soap and boiling, and then 
wringing it out in a solution of bichloride ofo f r Xese° n 
mercury i-iooo. The patent lint should be ren- 1 c i 1 n ° t t . hand 



Fig. 13. 






Nightingale Vv'rap. 



dered antiseptic in the same way. The gutta- 
percha tissue, patent lint, and oakum may be 
obtained at a drug store ; the gutta-percha tissue 
may be more readily obtained directly from a rub- 
ber store, where the syringe also may be bought. 
In winter it is well for the mother to be provided 
6 



82 OBSTETRICAL NURSING. 

Nightingale w ith a " Nightingale wrap." This is made of two 
yards of flannel of ordinary width. A straight slit, 
six inches deep, is cut in the middle of one side, 
the points so formed being turned back to form a 
collar. The corners farthest from this collar are 
also turned back to form cuffs. The whole may 
be bound or pinked around the edge and fastened 
by means of buttons or ribbons. 

Rubber For the confinement bed the patient should pro- 

cloth for con- 
finement vide two pieces of rubber cloth, a yard and a half 

square. For a single bed two rubber army blan- 
kets may be used, if, as in the maternity practice in 
the Woman's Hospital, it is desired to cover the 
whole bed. The arrangement of the bed will be 
explained in a later chapter. White rubber gum- 
cloth is the best when it is obtained in the piece. 
If the patient is poor, table oil-cloth may be used ; 
it is cheaper and answers the purpose as well, or 
layers of newspapers tacked together will make 
very good temporary pads. 

o?i°cTo h ^ piece of floor oil-cloth is the best protection 

for the carpet at the side of the bed. 

Precautions. Rubber-cloth should never be used but for one 
confinement. The rubber cracks when folded and 
put away and no longer serves its purpose of pro- 
tecting the bed. Then, too, it is very important to 
be sure that everything about the confinement bed 
is perfectly fresh and clean. Hence a rubber-cloth 



PREPARATIONS FOR THE LABOR. 83 

used for confinement should neither be borrowed 
nor lent. 

Sleeping on rubber-cloth makes a person per- Effect of 
spire, hence it is desirable to get rid of it as soon ?ubber g ° 
as one can. It is seldom necessary to use it after 
the fifth or sixth day. 

Other articles necessary to have on hand will be other 

articles for 

half a dozen old sheets, about a dozen towels, a confine - 

' ' ment room. 

new syringe (a fountain syringe, large size, is the 
best), a bed-pan (French pattern), nail-brush, white 
Castile soap, a jar of cosmoline or vaseline. 

I desire, in this connection, to emphasize the fact The 

x syringe. 

that the syringe should be a new one. This is an 
antiseptic precaution. Hence advise the patient 
strongly against the use of any syringe which may 
have been used for other purposes, however well it 
may work. Of course the borrowing of such an 
article from a neighbor or friend should be strongly 
discountenanced. 

Regarding the baby's clothes — if they are made infant's 
too elaborate they will not be washed often enough, 
hence they should be plain. As the depressing 
influences of cold are very injurious to babies, the 
clothing should be warm, hence a flannel garment 
with long sleeves and high neck should be worn 
next the skin — the thickness varying with the sea- 
son of the year. The activity of the life processes 
make it important that every organ of the body 



84 OBSTETRICAL NURSING. 

shall be unimpeded in its action and free from pres- 
sure, hence the clothes should be very loose and 
light \x\ weight. 

bab tfitf ° r ^he on ly articles absolutely needed to constitute 
an outfit are, ist, a soft flannel shirt, with high 
neck and long sleeves, opened in front. This is 

ve^t. under " better than the merino vests or the knit shirts, 
which shrink on washing, and are then difficult to 
put on and take off. 2d. A binder, or bandage of 
fine, soft flannel, four inches wide, and long enough 
to go around the abdomen once and lap over about 
one-third. This should be made without a hem, 
the raw edge being overstitched to prevent ravel- 

The binder. [ n g The binder is best fastened by means of two 
pieces of tape attached to one of its edges. 

This arrangement does away with the necessity 
for pins in fastening the binder, the pieces of tape 
being simply wound around the body to secure the 
binder and tucked in at one edge. Some prefer the 
knitted w T ool band, made of single zephyr and 

Knitted knitted in the ribbed stitch, as wristlets or mittens 

wool band. 7 

are often knit, to permit of greater elasticity. These 
bands are made a little narrower in the centre than 
at either extremity, so as to be held in place better. 
They are made perfectly circular, just like a wrist- 
let, and are so elastic that they can readily be drawn 
up over the limbs and adjusted to the body. 3d. 
Napkins. A napkin of cotton or linen diaper is the best ; Can- 



PREPARATIONS FOR THE LABOR. 85 

ton flannel makes a very poor baby's napkin, as it 
becomes stiff when washed. Napkins are generally 
made too large for a new-born baby, and require to 
be folded into too many thicknesses. A napkin 
which when folded once is half a yard square is of 
ample size. The number of napkins supplied 
should be generous, so as to permit of frequent 
washing and thorough airing. Napkins should 
always be fastened by safety-pins. For the pro- Protection 
tection of the outer garments from dampness due from 

dampness. 

to frequent urination, it is well to have a second 
napkin folded and laid beneath the baby's hips. 
The use of rubber-cloth over the napkin for this 
purpose is much to be condemned, as it overheats 
the parts and makes the skin tender. 4th. A 
flannel slip of heavier or lighter texture, according F ! annel 
to the season, serves the purpose both of petticoat 
and dress. This should be made just long enough 
to cover the baby's feet — about twenty-five inches 
from neck to hem, and should be fastened in front. 
The ordinary fashion of making a baby's clothes Length of 
very long is objectionable because of the greater gar 
weight of the clothes preventing free movement of 
the child's limbs and the development of its mus- 
cles. The object of fastening the clothing in front 
rather than in the back is to avoid the necessity of 
the baby's lying on the uneven surfaces produced 
by buttons, tapes, and hems, which no doubt are 



86 



OBSTETRICAL NURSING. 



Socks. 



Support 

from 

shoulders. 



often a source of discomfort to its tender skin. 
5th. Knit woolen socks are necessary to keep the 
baby's feet warm, and it is well to have them extend 
pretty well up the leg, reaching even to the knee, 
as cold feet are often an exciting cause for colic. 

The above are the only essential articles of cloth- 
ing for a baby. Should the mother prefer, for the 
sake of effect, to see her baby in white muslin, a 
Muslin slip, slip of muslin can be worn over the flannel slip. 
These garments do away with all waistbands and 
the constriction of the chest thereby induced. 
Should the garments be made with waistbands, 
they should be supported from the shoulders by 
means of straps, or armholes should be made in 
the bands, just as in the case of an older child; 
they will not need then to be drawn so tightly 
around the child to be retained in place. 

A blanket is not needed to wrap the baby in, in 
a room at the temperature of the lying-in room — 
from 68° to yo° ; but should it be carried from one 
room to another, or when it sleeps, a blanket, or 
some wrap, ranging in weight with the season, will 
need to be tlirown over it. 

When a baby has but little hair on its head, and 
shows a tendency to catch cold readily, a plain 
cambric or light flannel cap may be employed as a 
head covering. This is a preventive against ca- 
tarrhal troubles affecting the nose and throat. 



Blanket 
wrap. 



Cambric 
cap. 



PREPARATIONS FOR THE LABOR. 87 

A recent journal has described an outfit for babies 
which has obtained much favor among mothers. 
It is called, I believe, the " Gertrude Suit," and con-^ rtrude " 
sists of three garments ; the first, or undergarment, 
is made of soft flannel, and is long enough to ex- 
tend from the neck to ten inches below the feet. 
The next garment, cut in the same way, but a half 
inch larger and five inches longer, is made of mus- 
lin. Over these comes the "slip," also Princess 
style, and the only one of the garments with long 
sleeves. (This is the most objectionable feature of 
the suit ; a baby's arms should be well covered.) 
It has a longer skirt than either of the other gar- 
ments. All are fastened behind by small buttons. 
These three garments are put together and all 
slipped on to the baby at one time, facilitating the 
process of dressing very much. 

In our opinion, however, this suit has not the Advantages 

r ' y of Woman's 

same advantages as that worn in the Maternity Hospital 
of the Woman's Hospital of Philadelphia, and first 
described. The fastening of the clothing in front, 
the fewer number of articles comprising the ward- 
robe, and the fact that they may be very easily 
taken off and put on, while they meet all the re- 
quirements of warmth, looseness, and lightness, 
make this outfit preeminently a comfort to the baby. 

The articles provided for the baby-basket may be the baby's 
the following : — 



88 OBSTETRICAL NURSING. 

Three or four pieces of linen bobbin, about eight 
inches long. 

A pair of blunt-pointed scissors. 

Large and small safety pins. 

Several small squares of soft linen, about four 
inches square, for dressing the cord, and two inches 
square, for washing the eyes and mouth. 

A soft hairbrush. 

A powder box and puff, with lycopodium or fine 
starch powder. (The scented powders are often 
irritating.) 

A small jar of cold cream. 

Two soft towels. 

A full suit of clothes, as described above, for the 
baby. 

A woolen shawl or wrap. 



CHAPTER VIII. 

SIGNS OF APPROACHING LABOR— THE PROCESS 

OF LABOR. 



Certain changes take place during the latter part ^ 



Indications 



ap- 



of the ninth month which indicate that labor is f a r b °o r ching 
approaching. One of these is the sinking of the sinking of 

11 i i *-t-»i . r j_-\ abdominal 

abdominal enlargement. Ine upper part ol tne e niar g e- 
womb, which has at the beginning of the ninth m 
month been high enough to reach the pit of the 
stomach, comes down gradually to a point about 
midway between the extremity of the breast bone 
and the navel. This sinking of the womb is known 
as " descent" or " settling" of the child, and indi- 
cates that the head of the child, which is ordinarily 
the part to be born first, has stretched the lower 
part of the womb and is finding its way into the 
cavity of the pelvis, through which it must pass in 
the birth. Great relief to the mother results from Relief in 

breathing. 

this descent of the womb, as the lungs are no 
longer pressed upon to the same extent as before. 
The change in the position of the womb produces, Swe]lingof 
however, an increased amount of pressure on the 



lower ex 
tremities, 

lower portions of the body. Swelling of the lower pressure. 



s 9 



" False 
pains. 



pains. 



9O OBSTETRICAL NURSING. 

limbs is apt to result in consequence of this, and 
Piles. walking is rendered difficult. Piles or hemorrhoids 
are apt to form, and irritability of the bladder to 
exist. 

During the last two weeks of pregnancy patients 
are apt to suffer from what are known as " false 
pains." These are cramp-like pains, so much like 
labor pains that patients are often deceived by 
them, and led to imagine that the labor is really 
coming on. They are called " false pains " to dis- 
tinguish them from the pains of labor, which are 
•<True" known as " true pains." The way to distinguish 
between the two kinds of pains is to observe 
whether there is any regularity as to the time of 
their occurrence ; also, whether the interval grows 
shorter, and whether, with this shortening of the 
interval, the pains grow stronger. " False pains " 
are irregular in their occurrence, while " true pains," 
though starting perhaps at quite long intervals, as 
three-quarters of an hour or a half-hour apart, 
gradually come nearer together and grow stronger. 
" False pains," also, are generally located in the 
abdomen. " True pains " more frequently start in 
the back, coming forward to the abdomen and 
extending down the thighs. A strong "pain" is 
apt to be followed by one or two weaker pains. 
A nurse, if in doubt as to whether the pains are 
real labor pains or not, should have the physician 



THE PROCESS OF LABOR. 9 1 

sent for, who will make an examination to learn 
what the condition of the parts may be. A sign 
that makes it probable that the labor is really- 
coming on is the appearance of what is known as 
the " show," a discharge of mucus, tinged with 
blood, which comes from the mouth of the womb, 
and indicates that the stretching of the mouth of 
the womb is taking place. 

The whole process of labor is divided into three i S abfr. sof 
stages. The first is the stage of dilatation, when First stage, 
the mouth of the womb is stretching so as to allow 
the child to pass through it. With women who 
have never borne children, this stage lasts on an 
average fifteen hours, while it is a very variable 
period for those who have previously borne chil- 
dren — sometimes lasting but three or four hours ; 
the average time given is from seven to eleven hours- 

The second stage of labor begins after the com- Second 
pletion of the stretching of the mouth of the womb stage ' 
and ends with the birth of the child. For women 
with their first birth, this period lasts from an hour 
to an hour and a half; with others, from twenty 
minutes to an hour. 

The third stage of labor includes the interval Third 

m m stage. 

between the expulsion of the child and the coming 
away of the afterbirth — on an average a half an 
hour or twenty minutes. 



9 2 



OBSTETRICAL NURSING. 



" Bag of 

waters." 



Premature 
rupture of 
the mem- 
branes. 



The time for the entire labor, in a case where it 
is the first birth, is about seventeen hours. In 
cases where other children have previously been 
born, the average is from eight to twelve hours. 

The " bag of waters " is a sac of membranes in 
which the child is enclosed. Within this bag is 
found a liquid in which the child floats. The 
presence of this liquid between the child and the 
walls of the womb serves to protect it from the 
effect of falls or blows to which the mother may 
be subjected, and favors the regular development 
of the child. When labor begins with the stretch- 
ing of the mouth of the womb, a small portion of 
this sac is pushed out like a wedge beyond the rim 
of the dilating orifice, and helps thus in the dilata- 
tion. When the waters break early, labor is much 
more tedious because the even pressure of the bag 
of waters on the mouth of the womb is lost, and the 
stretching cannot, therefore, go on so rapidly and 
easily. As the mouth of the womb opens, the 
pouch formed by the bag of waters is pushed 
further and further out into the vagina, the pains 
become stronger, and the pouch at last bursts, 
letting the water escape. This is " the breaking 
of the waters, " called by physicians the " rupture 
of the membranes," and it should not take place 
before the mouth of the womb is fully open. 



THE PROCESS OF LABOR. 93 

Labor, however, sometimes begins with this loss 
of water, as has been said in the chapter on the 
accidents of pregnancy. 

The pains of the first stage of labor are cutting, 
grinding pains, very hard for the patient to bear, 
and causing her to be nervous and irritable. 

The cries made by the patient during the first p a "f e s n t f in 
stage of labor are very different from those of the labon 
second stage. They are cries of complaint and 
suffering, while during the second stage they are 
rather groans accompanying a bearing-down effort 
on the part of the patient. The pains of the second 
stage are called " forcing " or " bearing-down pains." 
An experienced woman will know, as soon as these 
pains begin, that the doctor should be on hand as 
soon as possible ; and she should send him a mes- 
sage which will lead him to realize the necessity 
for coming at once. 

The pains during the second stage increase in change in 

*■ . • ° o character 

strength and frequency; the patient holds her of P ains - 
breath and bears down forcibly with each pain. 
The effort causes her to become flushed and 
heated, and to break out into perspiration. 

During this time the head of the child is forced Preparation 
down the middle passage, or vagina, to the ex- ^ack for 
ternal opening. At the end of each pain the head f P chiYd°. n 
goes back a little, so that the birth-track may be 
very gradually stretched. With women who have 



94 OBSTETRICAL NURSING. 

previously borne children, there is often so much 
relaxation of the tissues forming this passage-way 
that the head of the child may be expelled by a 
single pain. This sudden birth of the head often 
causes very serious tears. 

chiid'sLad After the external opening has been sufficiently 
stretched by the slow advance of the head, it grad- 
ually works out altogether, and then the worst pain 

?f X r P e U st S o°f n ls over. There is then a short interval of rest before 
the remainder of the body is born, the shoulders 
coming first by a strong pain, after which the lower 
part of the body easily slips out. 

Expulsion The contraction of the womb, or " pains," now 

birth. cease altogether from five to twenty minutes or 

even half an hour, when there is again a little pain 
and the afterbirth comes. 

Liability of The above description is an account of what labor 

accidents L 

occurring, should be if perfectly natural. There are many emer- 
gencies which may arise in any case, hence, for the 
importance sa ke of the patient and nurse, every effort should 
physician to be made, even in what promises to be a normal 
sponsibUity. case, to have the doctor on hand in time. 



CHAPTER IX. 
DUTIES OF THE NURSE DURING LABOR. 
With the occurrence of the symptoms which Call for 

nurse. 

indicate the onset of labor, the nurse, if not already 
in the house, should be immediately sent for. 

A nurse should give very prompt attention to^ ecessit y 

° • j. i for prompt 

such a call, and lose no time in getting to the^ ntionto 
patient, as many women pass through the different 
stages of labor very rapidly. 

On arriving at the patient's house, the nurse a pp[°p"- 

& r y ate dress. 

should put on her working-clothes, which should 
always be scrupulously clean and of wash material. 
The uniform worn by the nurses of the Woman's 
Hospital, of Philadelphia, consists of a blue and 
white striped seersucker dress, very plainly made ; 
a large plain white apron, with bib, well protecting 
the dress ; over-sleeves, of same material as apron, 
for the protection of the dress-sleeves, and a white 
muslin Normandy cap. This makes a plain yet importance 

J y r J of neatness 

attractive dress — which is a matter of considerable in P ersonal 

appearance. 

importance to the patient, who gets her first impres- 
sions of her nurse through her personal appearance. 
Woolen dresses, or those made of any material 

95 



96 OBSTETRICAL NURSING. 

which will not bear frequent washing, should never 
importance be worn by a nurse. There is always the possibility 

of wearing . ■ m 

washdresses — m fact, the probability- — of such a dress having 

in nursing. \ ° 

been worn during her attendance upon some pre- 
vious case of illness, in which case it would greatly 
endanger the patient. The feeling of the wash 
dress as it comes in contact with the patient's skin, 
when the nurse lifts her or works about her, is 
much more agreeable thaji that of woolen stuffs. 
Then, too, it is more business-like, looks more like 
work, and gives the patient the comfortable feeling 
that a nurse means to help her, rather than to sit 
around as a fine lady, attending simply to the 
daintier parts of attendance upon the sick. I intro- 
duce this subject here because I find that many 
graduate nurses, in breaking their direct connection 
with their training-schools, set aside as a matter of 
small moment this requirement concerning dress 
— a requirement in which a most important prin- 
ciple is embodied and which demands the hearty 
support of every truly scientific nurse, 
importance Another important point! wish to mention here, 

of dressing ± x 

quickly. an d that is, that a nurse should learn to dress 
herself quickly, so that she can slip into the neces- 
sary garments in a very few minutes, and thus, by 
her promptness in reporting for duty, awaken the 
confidence so essential to her management of 
patients. 



DUTIES OF THE NURSE DURING LABOR. 97 

On entering the room where the patient is to be First duty 
found, while exchanging the necessary greetings, room. 
the nurse should exercise her powers of observation, 
and rapidly take in the state of affairs, forming her 
opinion as to how far the labor has probably P r o- bserva 
gressed. Should " pains " be occurring, she will « on ai ° n f s >. 
recognize, from what has been said in a preceding 
chapter of the pains characterizing the different 
stages of labor, whether the patient is really in 
labor or not, also, how much time is probably left 
for the making of preparations. She can learn from when pains 

1 . iri rr i began. 

the patient, in the intervals of her suffering, when 
the pains first began, how often they occur, whether 
the waters have broken, etc., so that she may know 
what message to send the doctor, should the neces- 5 ^^^ 

o ' the 

sity exist for so doing. After this duty has been per- P h y sician - 
formed, if labor has really begun, the nurse should 
give herself to the preparation of the patient and 
the room for the confinement. 

Preparation of the patient : The nurse should Preparation 
inquire of the patient whether her bowels have been ° pa 
freely moved recently. If not, a simple enema of 
soap and water may be given for the purpose of 
clearing out the lower bowel and making the ^^ n t0 
second stage of labor easier and cleaner. 

Inquiry should be made as to whether the patient ladder? 11 to 
has passed water freely. If not, she should be urged 



98 OBSTETRICAL NURSING. 

to make the attempt, and, if not successful, the 

physician should be notified. 
Warm bath. It is desirable, if there is time, to have the patient 
F^sh take a full warm bath and put on entirely fresh 

clothing. L J 

clothing. 
v a n -inaf tic ^ vaginal injection of some antiseptic solution 
injection. ma y ^^ ^ e g{ ven ^ anc [ the parts about the external 

generative organs washed off with an antiseptic 
solution. In the Woman's Hospital the vaginal in- 
jection consists of a solution of bichloride of mer- 
cury 1-8000. The external parts are washed off 
with a similar solution of 1-2000 or 1-4000. 
Preparation Tablets of bichloride of mercury may be obtained 

of antiseptic 

solutions, at any apothecary's, one of which, if added to a pint 

Bichloride of * *" * x 

mercury. Q f water, will give, as a rule, a solution of 1-1000, 
from which solutions of varying strength may be 
made up by the addition of more or less water. 
Thus, on adding seven parts of water to one part of 
the bichloride solution 1-1000, a solution of 1-8000 
may be obtained. It is always desirable that the 
nurse should have a little porcelain or agate-ware 
gill measure, by which she can readily and quickly 
prepare these solutions. If tablets cannot be 
obtained, powders of 7^ grs. each of bichloride 
of mercury, if added to a pint of water, will give a 
solution of 1-1000. 

Creoiine. Creoline, a coal-tar preparation, four times 



DUTIES OF THE NURSE DURING LABOR. 99 

stronger in its antiseptic properties than carbolic 
acid, may be used in place of bichloride of mercury. 
To make this, 1 drachm of the creoline should be 
added to the pint of water. Creoline, though not 
so strongly antiseptic as bichloride of mercury, has 
greatly come into favor of late, both because it 
does not have the same corroding effect on instru- 
ments which may be used, and because there is less 
liability of poisoning than in the use of bichloride 
of mercury. An objection has been raised to the^?^| c °^ nt 
use of creoline for vaginal injections, as it is claimed 
that its admixture with blood produces a tarry pre- 
cipitate. The coagulation of albumen in vaginal 
discharges, by the action of corrosive sublimate, is 
similarly claimed to deteriorate the value of the 
latter as an antiseptic agent. In cases when there 
is excessive discharge it is better, therefore, to sub- 
stitute a solution of permanganate of potassium, 
or carbolic acid. 

A nurse should never lose sight of the fact that Da . n § erof 

& poisoning. 

the corrosive sublimate (bichloride of mercury) 
tablets are a deadly poison, hence there should be 
no neglect as to care in their handling. 

Carbolic solutions are used in place of either embolic 

1 acid. 

of the above by some physicians. A two per cent, 
solution of the latter may be made up by adding 
2y 2 drachms to the pint of water. 

When the patient seems to be in active labor, the 



IOO 



OBSTETRICAL NURSING. 



Position 
until after 
examina- 
tion. 



Arrange- 
ment of 
hair. 



Confinement 
outfit. 



Necessity 
for exami- 
nation by 
physician. 



Prepara- 
tions for this 
examination. 



nurse should keep her lying down until after the 
physician has made an examination. He will then 
state whether the patient may sit up or walk about 
the room. 

Because of her long confinement to bed the hair 
of the patient should be arranged so that it will be 
most comfortable and not readily tangled. The 
best arrangement is that of parting the hair down 
the back of the head and braiding it into two plaits 
— one behind each ear. This leaves a smooth sur- 
face at the back of the head to lie upon. 

The outfit of the patient during the labor should 
consist of a merino vest, long night-dress, a pair 
of large, roomy, open drawers, and a pair of stock- 
ings. While walking about the room, and until 
the second stage of labor begins, she can wear a 
wrapper over the rest of her clothing and have on 
a pair of bedroom slippers, which can be easily 
slipped off when she needs to lie down. 

The patient should be told by the nurse of the 
necessity for an examination by the physician, 
particularly if this is her first labor. When the 
physician comes, the patient should be placed on 
the bed, near its edge, lying on her back or side, 
as he may prefer, with her limbs drawn up toward 
the abdomen. Her clothing should be lifted above 
the hips, and a sheet, or some light covering, used 
to protect the lower part of the body from exposure. 



DUTIES OF THE NURSE DURING LABOR. IOI 

A chair should be placed for the physician on the 
same side of the bed, close to its edge, facing the 
patient as she lies ; a jar of cosmoline or vaseline 
should be brought him, and all the necessary mate- 
rials provided for the oroper cleansing of his hands cleansing of 

* * a <-> physician s 

both before and after the examination; soap, nail- hands - 
brush, warm water and towels, and some disinfect- 
ant solution, as a bichloride of mercury solution of 
the strength 1-2000, or creoline, a drachm to the 
pint of water.* 

The preparation of the room and bed will next Preparation 

,, , . ofroom. 

require the nurse s attention. 

These preparations should be made as quietly as systematic 
possible. The nurse should have learned before- mem of 

articles 

hand where things are, and she should have had needed. 
them so arranged that but little will need to be 
done at the time, except to put them where they 
will be most convenient for use. It is well, if the 
patient is walking about, to have her go into the 
next room while the bed is made up. 

A single bed is always the most convenient in o7a P stngie 0n 
the management of a patient, but such are rarely 
found in private houses. The preparation of a 
single bed would be as follows : First, the mattress 
— preferably of hair — covered by a pad and rubber- 

* Some physicians prefer the use of a saturated solution of 
permanganate of potassium, regarding it as a more thorough 
antiseptic. 



102 



OBSTETRICAL NURSING. 



" Perma- 
nent bed. 



" Tempor- 
ary bed." 



Preparation 
of double 
bed. 



" Tempo- 
rary 

dressing.' 



protective across the middle of the bed, or covering 
the bed entire. (Rubber army-blankets are used in 
the Woman's Hospital for this purpose.) The 
under sheet covers this rubber, and a draw-sheet — 
a sheet folded four times in its length and placed 
across the portion of the bed upon which the hips 
would rest — comes next. (The folded side of the 
draw-sheet should be toward the head of the bed.) 
This constitutes the first dressing, or what is known 
as the " permanent bed." The different articles 
constituting this dressing are securely fastened 
down by safety-pins. Over the " permanent bed" 
comes the " temporary bed," consisting of a second 
gum blanket, covering the entire bed, a second 
under-sheet and draw-sheet. Covering these are 
the upper sheet, blanket, and spread. 

After the confinement, the " temporary bed " can 
be drawn from under the patient, leaving her lying 
on the " permanent bed." The change is accom- 
plished with much greater ease for both patient 
and nurse than the changing of the various articles 
separately. 

The double bed found in most private houses is 
arranged as follows : First, the ordinary dressing of 
the bed, the hair-mattress, pad, rubber-protective, 
under-sheet, and draw-sheet. Upon top of this 
dressing, at the lower right-hand corner of the bed, 
a " temporary dressing" should be arranged, about 



DUTIES OF THE NURSE DURING LABOR. IO3 

a yard and a half square, consisting of a rubber 
protective, or the paper pad before described, se- 
curely fastened down to the bed beneath, and 
covered, if rubber, simply by a folded sheet, like- 
wise fastened down by safety-pins. If the paper 
pad is used, an old comfortable or blanket will be 
needed beneath the sheet. The pillow for the 
patient should be placed at the upper and inner 
corner of this square. After the delivery, she can 
be lifted to the upper part of the bed, and the 
"temporary dressing" removed. 

The sheet, blanket, and spread which are to serve 
as her covering after the delivery can be kept from 
soiling during the labor if folded upon themselves 
several times and carried to the extreme edge of^ 

1 emporary 

the left side of the bed. Another sheet and blan- a ^ange- 

ment of 

ket may be used as temporary covering during the covers - 
delivery. It is so important that a patient shall be 
moved as little as possible immediately after the 
labor, because of the tendency to bleeding pro- 
duced by motion, that the nurse should study 
carefully the best methods of protecting patient 
and bed from soiling, so that it will be necessary 
to do but little in the way of changing the clothing. 

The piece of floor oil-cloth must be spread at Protection 

■ L x of floor at 

the side of the bed, extending from a foot to afoot sideofbed - 
and a half under the bed. 

There should be a bureau with a set of drawers, 



104 



OBSTETRICAL NURSING. 



System in 
arranging 
articles in 
bureau 
drawers. 



Change of 
clothing for 
mother. 



Articles for 

baby's 

basket. 



or a closet, with shelves, in the room, given up to 
the nurse for the keeping of the various articles 
she may need, and these articles should be con- 
veniently arranged so that there may be no confu- 
sion in obtaining them when required at any time. 
One drawer or shelf should contain sheets ; another 
towels and napkins and soft, clean muslin or linen 
rags, to be used as napkins during the delivery ; 
a third should contain changes of underwear for 
the patient, and a fourth the baby's wardrobe. 

A change of clothing for the mother should be 
placed — if it is warm weather — in the sun by a 
window ; if in winter, by the register or stove, so 
as to be dry and warm should it be needed. 

The baby's suit should in the same way be aired 
and warmed. The baby's basket should be placed 
on a chair or stand near the register, with all the 
necessary articles for its toilet and bath — a baby's 
bath-tub or an ordinary foot-tub, soft towels, nurse's 
flannel bathing-apron, a little rendered lard in a jar, 
etc. Two pieces of bobbin, each eight inches in 
length, should be put in a little vessel containing 
some bichloride solution, 1-4000. These, with a 
pair of blunt scissors, should be placed where they 
can be conveniently reached for the tying of the 
cord: Some small squares of soft muslin or linen 
should be placed where they will be convenient for 
the immediate cleansing of the child's eyes after 



DUTIES OF THE NURSE DURING LABOR. 105 

expulsion of the head. A flannel blanket or good 
warm flannel petticoat should be provided for re- 
ceiving the child upon its birth. The baby's crib 
should also be prepared for its reception. 

Beneath the bed there should be two chambers Receptacles 

needed. 

— one for urine and one for the afterbirth, or a tin 
basin may be provided for the latter. 

Some receptacle should be in readiness for the ^strum^us. 
doctor's instruments, should they have to be used. 
The small pitcher which ordinarily accompanies 
the modern chamber sets serves this purpose 
very nicely. 

A vessel for the patient to vomit in should be on Receptacle 
hand — a chamber, or even a chamber-lid, will do to vomit in. 
very well. 

A basin filled with a warm solution of bichloride Foranti - 

septic 

of mercury, 1-4000 or 1-2000, should stand near the solution - 
bed, so that the nurse or physician may repeatedly 
cleanse the external organs of generation of all 
discharges during the progress of the labor. The 
solution in this basin should be frequently changed. 

A sufficient number of soft linen or muslin rags soft linen or 
will also be necessary for this purpose. pieces 1 ! 

Agate, porcelain, or china basins are necessary Kind of 
when bichloride solutions are used. For creoline needed, 
ordinary tin basins will do. 

The nurse should never allow anything from the 
kitchen to be pressed into service for such an occa- 



io6 



OBSTETRICAL NURSING. 



Other 

articles. 

needed. 



Plentiful 
supply of 
hot water. 



Stimulants. 



sion. The indiscriminate use of pans, basins, cups, 
and saucers is certainly vulgar, to say the least. 
The " eternal fitness of things " should never be 
lost sight of. 

A urinal, or a soap-cup, which is a good substi- 
tute ; a silver catheter, and an English rubber cathe- 
ter, No. 8 or No. 9 ; a bed-pan, and the other re- 
ceptacles for the various purposes above referred 
to, may be placed for convenience beneath the bed. 

A towel-rack near by should contain at least 
half a dozen fresh towels. 

A few napkins, a supply of soft rags, a jar of cos- 
moline, a waste-bucket or slop-jar, with a lid, should 
be found in the room ; and an abundant supply of 
hot and cold water. 

As soon 'as the patient is known to be in labor, 
the nurse should go to the kitchen to see that the 
fire is good, and that plenty of water is put on to 
boil. An arrangement should also be made by 
which some member of the family will be prepared 
to respond to the nurse's call for more hot water 
when it is required. The abdominal bandage for 
the patient, with a set of the dressings and a pin- 
cushion containing safety-pins, should be placed on 
the stand beside the bed. 

A bottle of whisky or brandy and one of harts- 
horn should be provided. 

A pitcher of cool water and a tumbler should be 



DUTIES OF THE NURSE DURING LABOR. IO7 

found in the room, as the patient may need a refresh- 
ing drink during the progress of the labor. A 
feeder is best provided for the patient's use, as she 
can then drink Iving down. 

The arrangement of the patient's clothes to keep Arrange- 

o Jr r ment of 

them from soiling during the expulsive stage ofp^^' 5 
labor will require some care on the part of the 
nurse. The night-dress or vest should be folded 
or rolled up beneath the arm-pits and fastened with 
safety-pins over the right side of the chest. If the 
patient wears large drawers, no further protection 
than the cover-sheet maybe necessary. Some pre- 
fer having a sheet adjusted around the waist, above 
the abdomen, and pinned under the clothing to the 
right side, the long end of the sheet which remains, 
and which should be the anterior part, is plaited 
up and fastened also beneath the right arm by 
means of safety-pins. The sheet thus resembles a 
skirt opened at the right side. 

During the early stage of labor the nurse will nmst ° f 
need to encourage the patient, and by a sensible, stage of rst 
quiet, yet cheerful bearing keep her strong. It is Encom-age- 
of no use for patients to hold their breath and bear™^ ance 
down during each pain in this stage, and nurses ^ e n anng 
should never urge their patients to do so. It should efforts ' 
be left to the physician to decide when bearing- 
down efforts are desirable. The pressure of thebadT" 
nurse's hand upon the back during a pain often gives 



io8 



OBSTETRICAL NURSING. 



Nourish- 
ment. 



Vomiting. 



Cramps. 



Exclusion of 
company. 



great relief to the patient, while the occasional 
bathing of the face and hands with cold water is 
refreshing. Frequent sips of cold water may be 
permitted. 

Nourishment in the form of beef-tea, gruel, milk, 
and tea may be given from time to time if the labor 
be long. No stimulants should be given without 
the direction of the physician. 

Vomiting is a troublesome though not necessarily 
a dangerous symptom during delivery. In fact, the 
relaxation it produces is often desirable. If it is 
excessive, however, a little iced soda water may 
check it. 

Cramps in the lower limbs are a very frequent 
accompaniment of the second stage of labor. Re- 
lief may be obtained by stretching the limb straight 
out, gently rubbing the painful muscles, or grasping 
and holding them. 

Friends and neighbors should, if possible, be 
excluded from a confinement room. Their injudi- 
cious tales and expressions of sympathy are often 
absolutely painful. The nurse has to manage this 
with great tact. She can generally succeed best by 
stating to the friends that it is the physician's wish 
she should do so, and her relations toward the 
physician require that she should implicitly observe 
his directions. If the nurse does not allow herself 
to become familiar with her patients, but maintains 



DUTIES OF THE NURSE DURING LABOR. IO9 

a quiet dignity in the carrying out of her directions, 
her requests will generally be observed. 

Tact is a magic wand by which human beings Tact. 
can accomplish miracles in the way of subduing the 
obstinate. Happy is the nurse who possesses it ! 
The best rule for acquiring it is the Golden Rule, 
" Do unto others as you would that they should 
do to you." A strict observance of this will insure 
a kindness of tone and manner in the making of 
requests which will win consent when it would not 
otherwise be granted. 

One of the most important duties of the nurse changing 

of napkins 

during the confinement is the frequent changing of and other 

j. o o antiseptic 

napkins, draw-sheets, towels, etc, used about the measures. 
patient. Also the frequent renewal of the antiseptic 
solutions to be used about her, or for the doctor's 
hands. 

Antisepsis means, literally, " against poisoning," Antisepsis. 
and implies the careful removal of all sources of 
poisoning, such as would come from decomposing 
blood and discharges or dirty articles. The physi- 
cian's and nurse's hands, therefore, require a special 
preparation for the labor in their thorough disinfec- 
tion. During the course of the labor the hands 
should be thoroughly cleansed with a bichloride 
solution whenever they have touched anything 
unclean, or whenever they come in contact with the 
genital organs. 



no 



OBSTETRICAL NURSING. 



Position for 
delivery. 



Position 
during third, 
stage of 
labor. 

Prepara- 
tions for 
receiving 
child. 

Protection 
of mother. 

Cleansing 
of baby's 
eyes. 



Removal 
of child. 



The patient may be delivered on her back or 
lying on her left side. When the physician desires 
the change of position, the nurse must help the 
patient to turn on her side and bring her hips close 
down to the edge of the bed. The upper or right 
limb will then have to be supported by the nurse, 
in order to well separate the thighs until the 
delivery is effected. (When there is insufficient 
help, a pillow may be used between the knees.) 
She will have to get on the bed close to the patient 
for this, and hold the leg at knee and ankle. After 
the child has come, she should help to turn the 
patient in the bed, bring a flannel wrap to put the 
baby in as it lies on the bed before the tying of the 
cord, and throw a covering over the mother's chest. 
She should then wipe the baby's eyes with a fine, 
soft piece of linen dipped in tepid water, or a satu- 
rated solution of boric acid ; should bring the 
doctor the scissors and bobbin, and have ready a 
sheet for receiving the child and a vessel for the 
afterbirth. She should hold the sheet doubled 
upon her outstretched arms, the side toward her 
being held up by her chin. On receiving the baby 
with its flannel covering, she allows the edge of 
the sheet held up by her chin to drop down over 
the child. She then folds over the hanging ends, 
so as thoroughly to cover the child, and places the 
little bundle in a crib, to await further attentions, 



DUTIES OF THE NURSE DURING LABOR. Ill 

until the mother has been made comfortable. 
Should the child breathe imperfectly, the physician 
will give it his own attention or direct the nurse 
what to do. 

The vessel containing the afterbirth, if the latter ^ b °f th 
has been detached from the child, may be placed 
temporarily under the bed, to await the physician's 
examination. If the cord has not yet been tied, 
the vessel may be put in the crib with the baby. 
Many physicians do not tie the cord, or navel-string 
until there is no further pulsation in the vessels. 

Should the physician not desire to do so, the cleansing 

• mother after 

nurse should next attend to the cleansing of the labor, 
mother's external parts by means of soft cloths 
dipped in a solution of bichloride of mercury i- 
4000. 

Many physicians make a practice of using ay^^ ns 
vaginal injection of some disinfectant solution 
immediately after delivery. It will be the nurse's 
duty to prepare this should it be called for. The Removal of 
" temporary dressing "should be removed from the Sothing. 
patient, and she should be gently lifted on to the 
upper portion of the bed. The binder and dress- of binder 

and dress- 
ings must next be applied. ings. 

" The binder must be rolled up to half its length, 
and the rolled portion passed beneath the patient's 
back. It is then caught on the other side and un- 
rolled, straightened so as to be free from wrinkles, 



112 OBSTETRICAL NURSING. 

and made to encircle the hips tightly. The over- 
lapping ends are then fastened together by means 
of safety-pins down the front." The middle por- 
tion of the bandage should be tightened first, as 
the firmest pressure should be directly over the 
upper portion of the womb. The lower portion of 
the bandage is fastened next, and the pins in the 
upper portion placed last, as this does not need to 
be so firmly applied. 

The antiseptic dressings should next be applied 
in the order described in a preceding chapter. The 
napkin is spread out and fastened to the abdominal 
bandage anteriorly, so as to fit over the convexity 
of the upper portion of the external organs of gener- 
ation and extend from groin to groin. Posteriorly 
it is fastened to the abdominal bandage by but one 
safety-pin. This makes an " occlusion dressing." 
Making The patient's body-clothing should then be un- 

comfortable, fastened and drawn down (her drawers and stock- 
ings should have been removed with the " tempor- 
ary dressing "). The coverings of the bed are 
drawn up over her, and she is allowed to lie quietly 
until the nurse cleans up the room and makes pre- 
parations for washing the baby. 
" w y a S tch a " s ^he physician generally remains with the patient 
an hour after the delivery, taking her temperature 
and pulse, and w r atching the condition of the womb, 
to insure against danger of hemorrhage from want 
of proper contractions. 



DUTIES OF THE NURSE DURING LABOR. II3 

After the doctor leaves, this duty devolves upon Nurse's 
the nurse, who should examine the dressings fre- the P h ys i- 

1 r C * an l eaves « 

quently to see that the bleeding is not too profuse, 
and place her hand over the lower part of the abdo- 
men to feel the womb, which, if properly contracted, 
should be a round, hard body about the size of a 
child's head, immediately above the pubic bone, 
and not reaching higher than the navel. The con- 
sideration of the accidents of labor and the care of 
the infant will be treated in other chapters. 



CHAPTER X. 



ACCIDENTS AND EMERGENCIES OF LABOR. 



Absence of 
physician 
during 
delivery. 



Occurrence 
of pains. 

Second 
stage of 
labor. 



Lateral 
position. 



Women who have borne children before are apt 
to have rapid labors, hence a nurse should be on 
her guard when in attendance upon such a patient, 
watching for the symptoms of approaching labor, 
and notifying the physician earlier than she would 
feel warranted in doing with a patient expecting her 
first confinement. As soon as the nurse suspects 
that labor pains have begun, she should put her 
patient to bed. When " bearing-down " pains begin, 
the patient should not get up even to use the cham- 
ber. A bed-pan should be used. The patient 
should not be allowed, when the pains come on, to 
catch hold of anything to increase the force of her 
effort. Above all, the nurse should not tell her to 
bear down. 

The strength of the pains is somewhat modified 
if the patient is kept on her side. This position 
is also safer for the perineum, which does not so 
directly get the full force of a pain as when the 
patient lies on her back. The left side is preferable, 

114 



ACCIDENTS AND EMERGENCIES OF LABOR. 115 

as it enables the nurse to use her right hand to 
greater advantage. 

Should the child's head come down so that it can Care of 

perineum. 

be seen at the entrance to the vagina, the nurse 
should place herself on the right side of the bed, 
and as the patient lies on her left side, with the hips 
well drawn to the edge of the bed, the nurse should 
gently hold back the baby's head during a pain. s ^?, or ^ of d 
This is to prevent a tear from occurring by the sud- 
den expulsion of the head. She should favor the 
gradual stretching of the parts. She should avoid 
interfering in any way, as in making efforts to en- 
large the opening by stretching it with the fingers, 
etc. All such attempts will inevitably result in 
harm. When the opening is sufficiently stretched, 
the head will slip out of itself. The passage of the Delivery of 
child's head is rendered easier if the patient's knees 
are separated by a pillow. The nurse should sim- 
ply continue to support the head with her hand, 
and as soon as the head is born her left hand 
should be placed over the mother's abdomen, rest- 
ing upon the womb, which may be distinctly felt^P° f 
through the abdominal walls. The pressure of the 
hand acts as a stimulant to the womb and induces 
good contractions. A tendency to hemorrhage is 
thus averted. The right hand of the nurse should 
support the child's head. With one finger she . 
should feel around the baby's neck to learn whether 



Il6 OBSTETRICAL NURSING. 

it is encircled by a loop of the navel-string or cord. 
Loosening If so, she should gently pull first on one side and 

of cord. ' & J r 

then on the other, of the cord, to see which end 
gives. This loosens the pressure and prevents the 
stoppage of the circulation in both cord and child's 
neck. 

?ody! eryof When, after a pause, the pains start up again to 
expel the rest of the child's body, the nurse had 
better have some one instructed how to hold the 
womb properly, as both her own hands will be 
needed to receive the body of the child as it is ex- 
pelled. The mother herself may be shown how to 
make this pressure over the womb. If there is no 
one to make this compression of the womb, the 
nurse should try to manage the baby with one 
hand and keep up the pressure over the lower 

Care of part of the abdomen with the other. The flannel 

infant. 

wrap for the baby may be put close up to the 
mother's hips, and the nurse can manage with one 
hand to lay the baby down on this, cover it up, and 
draw it far enough away from the mother's hips 
to keep it out of the discharges. She should see 
that the baby's mouth is free from liquids. The 
little finger of her right hand acting as a hook, the 
end of the finger should be passed in at one corner 
of the baby's mouth and out at the other corner, 
thus scooping out any liquids that may have been 
drawn in during the birth. She should be careful 



ACCIDENTS AND EMERGENCIES OF LABOR. II7 

to see that the cord is not dragged upon and that 
the baby breathes well. Babies usually cry lustily 
just after the birth. This should be a welcome 
sound to both nurse and mother, as it ensures ex- 
pansion of the lungs. Occasionally, a child will be 
born with what is known as a "veil" or "caul," a£^ ul „ 
portion of the membranes, drawn tightly over the 
face. This may cause death from suffocation unless 
it is quickly seized by the fingers and torn off, so 
as to free the child's mouth and nose. 

If the baby is apparently lifeless when born, Resusdta- 
besides the measures spoken of for clearing its infant - 
mouth of liquids, it may be turned over on its 
face, to empty out the discharges from the air- 
passages, and efforts should be made to start 
breathing. The head of the child should be 
lowered, to keep as much blood there as possible. 

The back may be slapped — several short, quick 
slaps given over the buttocks. A stream of cold 
water may be poured on the chest just for a moment, 
and this repeated several times. 

If these fail, the nurse may breathe into the Artificial 

breathing 

baby's mouth. To do this properly, the baby's 
nose should be held, the nurse's lips placed closely 
over the baby's open mouth, as she breathes into 
it, then the nurse's mouth is removed and the grasp 
on the nose loosened, the sides of the child's chest 
being pressed upon to press out the air. The 



u8 



OBSTETRICAL NURSING. 



number of breaths given by the nurse in a minute 
should not at first exceed twelve. 
Sylvester's Another valuable method of carrying on artifi- 

method. # J ° 

cial respiration is known as Sylvester's method. 
The baby is placed on its back, with a roll made by 



Fig. 14. 




Sylvester's Method of Resuscitation (First Movement). 

a towel placed under its shoulders. The head is 
thrown back. The arms are then slowly lifted and 
carried well up over the head. They are held in 






ACCIDENTS AND EMERGENCIES OF LABOR. I I9 

this position until five can be slowly counted. By 
this movement the ribs are elevated, the chest ex- 
panded, and a vacuum produced in the lungs into 
which the air rushes ; or, in other words, the move- 



Fig. 15. 




ment produces " inspiration." The arms are then 
carried slowly downward, placed by the side, and 
pressed inward against the chest. This forces out 
the air and produces " expiration." These move- 



120 OBSTETRICAL NURSING. 

ments should be slow, repeated about fifteen times 
during each minute, and should be carried on until 
the breathing becomes regular. Should there be 
no sign of life, the efforts at resuscitation should not 
be abandoned for at least two hours after the birth. 
mithoT' 5 A third method, which, however, requires the 
separation of the baby from the afterbirth, is most 
excellent. It is known as Schultze's method. It 
would be more apt to be practiced by a physician, 
because it necessitates the early and quick tying of 
the cord and is only of advantage when practiced 
at once after the delivery. The method is as fol- 
lows : The child is seized by the shoulders and 
upper arms and swung head downward above the 
operator's head. The weight of the lower part of 
the body is thus thrown upon the chest, and any 
liquids which may have been drawn into the air- 
passages are thus forced out. Being held thus for 
a time, while the operator counts five, the body is 
then brought down in reversed position between the 
operator's knees. The weight of the lower extremi- 
ties is thus made to drag upon the chest and enlarge 
its capacity for the entrance of air. These two 
movements may be kept up for considerable time.* 

* The order of these movements as given by Schultze is reversed. 
The upward movement is practiced first in the Woman's Hospital, 
as it is found that the air-passages are thus best cleared of mucus 
and discharges before an act of inspiration is encouraged. 



ACCIDENTS AND EMERGENCIES OF LABOR. 121 

Fig. 16. 




Schultze's Method of Resuscitation (First Movement). 



122 



OBSTETRICAL NURSING. 



Warm 
baths. 



Alternating with artificial respiration, warm baths 



Fig. 17. 




Schultze's Method of Resuscitation (Second Movement). 



may be employed from time to time. The tem- 
perature of the bath should be ioo° Fahr. After 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 23 

breathing is established, the child should be placed After-care, 
in warm wraps, with bottles of hot water around it. 

If all is well with the child, it is best not to tie Tying of 

cord. 

the cord until all pulsation ceases in it. This 
measure is thought to save the child some loss of 
blood. As the pulsation may last for an hour or 
more after the delivery, the afterbirth is generally 
expelled before the cord is tied. To tie the cord, 
two pieces of bobbin, each eight inches long, dipped 
in a bichloride solution 1-4000, or in some other 
antiseptic solution, should be used. The first liga- 
ture should be placed three inches from the child's 
abdomen. The string should be carried under- 
neath the cord. In making the first tie, two twists 
instead of one should be taken to keep it from slip- 
ping. If the thumbs are placed upon the string in 
tying, the ligature can be drawn more tightly, and 
the grasp of the ends of the bobbin is more secure. 
The second knot is tied the same way. ' The ends 
may then be looped, making a bow-knot. The 
cord should be stripped, that is, the blood remain- 
ing in the vessels squeezed out toward the afterbirth, 
before each ligature is thrown around it. The 
second ligature is one inch further away from the 
insertion of the cord into the child's abdomen. 
After this second ligature is tightened, hold the 
cord with the forefinger and middle finger at the 
ligature nearest the child, the thumb and other 



124 OBSTETRICAL NURSING. 

fingers at the other ligature, and cut it with a pair 
of dull scissors between these points. The extrem- 
ities of the scissors are thus made to look toward 
the palm of the hand, and a sudden movement on 
the part of the child does not result in the same 
danger to it as there would be were the points not 
thus protected. After the cord is cut, squeeze the 
remaining blood out from the end next the child. 
The scissors for this purpose are preferably dull, as 
the more ragged wound thus produced favors the 
closure of the blood-vessels. This lesson may be 
learned from nature, the lower animals gnawing off 
the cord after giving birth to their young, and thus 
no doubt decreasing the danger of bleeding. 

Position The best position for the mother during the 

stage of delivery of the afterbirth is on her back, hence, 
she may be turned after the nurse has satisfied her- 
self that the baby is in good condition. 

Twins. Very occasionally, on placing her hand over the 

abdomen, after the delivery of the child, the nurse 
may feel another child there. In this case she must 
simply keep the womb well contracted by rubbing 
it gently through the abdominal walls, and wait for 
nature to go on with the work of expulsion. This 
baby must be cared for as the other. 

Delivery of The afterbirth generally comes away within 
twenty minutes after the child's birth. Two or 
three pains occur, during which the nurse should 



ACCIDENTS AND EMERGENCIES OF LABOR. 125 

keep the womb in the middle line of the abdomen 
and make gentle pressure backward and downward. 
With her right hand she should seize the afterbirth 
and membranes and twist them around several 
times to make a cord of the membranes, so that 
they may not tear, but all be expelled at once. A 
discharge of blood and some clots generally follows 
the delivery of the afterbirth. The nurse's left 
hand should still be kept carefully over the womb, 
which should feel hard and firm and should not 
reach above the navel. If it does not feel firm, rub- 
bing over the lower part of the abdomen should 
again be resorted to until the round, hard body is 
felt. 

If the afterbirth does not come for an hour, and 
the physician has not yet come, send for another 
doctor. 

After the afterbirth has come, it should be put Examina- 
in a clean vessel, and, if detached from the baby, afterbirth. 
put in an adjoining room for the doctor to examine 
when he comes. Insist upon his seeing it, to find 
out whether it is all there. Have the baby removed 
to its crib and placed on its right side and properly 
covered. 

Watch the womb carefully until the doctor comes. Care after 

third stcisrG 

If it be firmly contracted, and no more blood be of labor, 
flowing from the vagina, place some dry napkins or 
a clean sheet under the patient, and wash off the 



126 



OBSTETRICAL NURSING. 



Cleansing of thighs and surrounding parts with warm water con- 
taining bichloride in the strength of 1-4000, and 
dry with a soft cloth. 

change of Slip the soiled clothing- from under the patient, 

clothing. * o r 1 

Binder and and then apply the binder and dressings, and make 
her comfortable. 



Report. 



Breech 
delivery. 



Hemor- 
rhage. 



As soon as the doctor comes, report to him the 
exact time when the waters broke, when the baby 
was born, and when the afterbirth came. It is 
always best for a nurse to keep a written report 
with a statement of what she did. She should not, 
however, neglect her patient for the purpose of per- 
fecting her report. 

Sometimes a nurse has the misfortune to be the 
only attendant at a breech delivery, that is, instead 
of the child's head coming first, the breech passes 
out from the birth-canal. Delivery in this manner 
is very dangerous to the life of the child. The 
nurse should do absolutely nothing here, as she 
would only make matters worse in trying to assist. 
These deliveries are long enough, as a rule, to give 
ample time for the summoning of some doctor to 
take charge of the case. In all breech cases the 
child is apt to need to be resuscitated, if it is alive 
at all ; hence plenty of warm water, etc., should be 
ready for the bath. 

Flooding from the womb, or " uterine hemor- 
rhage," is apt to occur either within the first twenty- 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 27 

four to forty-eight hours after the birth, when it is 
called "primary hemorrhage;" or, it may occur 
some days after, when it is " secondary hemor- 
rhage." The appearance of blood, either a constant 
oozing or a sudden gush from the vagina, is, of 
course, the earliest symptom. 

A pulse of over ioo in a patient freshly confined 
should make the nurse exceedingly watchful in this 
respect, as it betokens a liability to hemorrhage. 
Should the flow continue, the patient becomes pale, 
faint, restless, gasps for breath, and finally dies 
unless the hemorrhage is checked. A nurse should, 
of course, have the physician sent for at once, 
although he may have just left the house, or 
another doctor should be summoned. In the 
meantime, her first thought should be of the uterus 
and its probable condition of relaxation. The ban- 
dage, if applied, should be hastily removed and the 
hand placed over the lower part of the abdomen. 
If the womb is not felt, rub vigorously until it con- 
tracts and is felt again as a round, hard body. 
Keep on rubbing and holding. The nurse should 
never take her hand off the abdomen until the doc- 
tor comes. Direct some one else to take the pillows 
from under the patient's head, have the foot of the 
bed elevated, to keep the blood in the head and 
prevent fainting, which induces heart-clot. Have 
the foot of the bed placed on the seats of chairs. 



128 



OBSTETRICAL NURSING. 



The patient may be fanned, cold water given her 
to drink, hartshorn to smell. She should not be 
allowed even to turn in bed or lift her head. If the 
doctor has left ergot, one teaspoonful of the fluid 
extract may be given in a tablespoonful of water. 

Fig. 18. 




Position of Patient in Hemorrhage after Labor. 



The patient should receive this without lifting her 
head. Plenty of hot water should be on hand, the 
water in the tea-kettle boiling. If the physician 
delays his coming and the flow continues, repeated 
hot-water injections of about U5°-I20° should be 
given into the vagina. 
Convulsions. Convulsions may come on during the labor as 
during the pregnancy. Their management would 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 29 

be the same as that suggested for convulsions 
during pregnancy. 

Other accidents, such as rupture of the uterus Rupture of 

x uterus. 

or the coming down of an arm or hand, or the navel- _ . 

25 ' Prolapses. 

string in advance of the usual part to come first, are 
conditions in which the nurse can do nothing, 
except to keep the patient as quiet as she can, and 
meddle as little as possible until the doctor comes, 
for whom, of course, she must at once send. 

At no time, in the management of a case, should Demeanor 

& 'of nurse. 

a nurse express surprise or consternation, nor 
should her manner indicate that she has such feel- 
ings. Like a true soldier, she must bravely and 
quietly face the most critical situations and meet 
their demands. She should by her manner give the 
mother to feel that all life's vicissitudes are best met 
by a quiet self-control. 

Fortunately, deaths during delivery in this en- Liability to 

ctcciQcnts 

lightened age are few ; for the methods of averting during 
accidents at such times have been so thoroughly 
studied, that accidents themselves are very rare. 

As operative procedures during the course of aPrepara- 

tions for 

delivery may have to be resorted to very suddenly obstetrical 

operations. 

and unexpectedly, a nurse should have things in 
readiness should the emergency arise. The especial 
preparations necessary will consist in the making of 
a cone of stiff paper, into- which a towel is fitted, for 
the purpose of giving the patient ether ; arrange- 
9 



1 30 OBSTETRICAL NURSING. 

ments for an abundant supply of hot water, to be 
had at a moment's notice ; facilities for making up 
antiseptic solutions quickly ; a small pitcher con- 
taining a warm two per cent, creoline solution for 
the physician's instruments ; some kind of grease, as 
carbolized cosmoline, for lubricating these instru- 
ments when desired ; English rubber catheter and 
urinal conveniently at hand ; a basin with a two per 
cent, carbolic solution for needles, sutures, and 
scissors ; absorbent cotton in small pads, or soft 
linen rags dipped in an antiseptic solution, to be 
used instead of sponges j sufficient protection for 
the floor at the side of the bed ; and preparations 
for resuscitation of the infant. 

The position of the patient for most obstetric 
operations will be across the bed, with her hips well 
s-bed." over the edge. This is called a " cross-bed." 
Physicians generally call simply for a cross-bed, in 
desiring the nurse to make preparations for an 
operation, and she should understand that this refers 
to the arrangement of protectives and sheets, adjust- 
ment of pillow, and placing of patient in proper 
position. Should there not be a sufficient number 
of persons to have one hold each leg, chairs should 
be placed in such a way at the side of the bed as to 
support the widely separated feet. A chair for the 
physician should be placed between these, facing 
the bed. As there is usually some assistant to give 



'cross- 



ACCIDENTS AND EMERGENCIES OF LABOR. I3I 

the ether, the nurse will need to help in keeping the 
limbs apart and in giving the physician any other 
aid she can in the supply of the various articles as 
they are needed. Should the physician desire her 
to give the ether, her whole attention should be 
devoted to administering the anaesthetic and seeing 
that the patient keeps in good condition. Strict 
watch should be kept over the respirations and the 
pulse. Difficult breathing, or a stoppage in the 
respirations, weakness or irregularity of the pulse, 
blueness of the face and lips, should at once be called 
to the physician's notice, the ether cone being re- 
moved from the patient's face. After the patient is 
once well under ether, it takes but little to keep up 
the anaesthesia, so that the nurse should use the 
ether sparingly ; a few drops every few minutes 
upon the towel are, as a rule, sufficient. After 
etherization the patient may vomit, and there will 
be greater tendency to bleeding because of the 
relaxation induced by the anaesthesia, hence 
the nurse should exercise special^ watchful- 
ness and care over the patient. The vomit- 
ing is often relieved by a mustard paste over the 
stomach, while the bleeding may be controlled by 
the hand placed over the lower part of the abdomen, 
which, by making pressure over the womb, insures 
good contractions. After the nausea is relieved, 
ergot, if prescribed by the physician, may be given. 



CHAPTER XL 

CARE OF THE NEW-BORN INFANT. 

The mother being made comfortable after her 
delivery, the nurse should turn her attention to the 
infant. 

Everything needed for the baby's first" toilet 
should be collected and placed conveniently at hand, 
near the register, stove, or open fireplace. 
Prepara- The nurse should put on a flannel apron, or pin 

tions for the * ~ ' r 

first bath. a crib-blanket or flannel petticoat over her lap. 
The best bath-apron is one consisting of two pieces 
of flannel fastened to the same waistband. The 
lower piece is the one on which the baby lies ; the 
upper serves as a covering. A pitcher of warm 
water and one of cold must be provided, the baby's 
bath-tub being placed near them, the baby-basket, 
suit of aired clothing, and jar of rendered lard or oil 
within reach. The nurse should pick the baby up 
with its wraps and place it in her lap as she seats 
herself on a low chair or stool near the fireplace. 

The baby will be found to be covered over por- 
tions of its body by a white, greasy substance, called 

132 



Vernix 
caseosa. 



CARE OF THE NEW-BORN INFANT. 1 33 

" vernix caseosa," or " cheesy varnish. " This sub- 
stance is found in greatest quantity on portions of 
the body subjected to friction while in the womb, 
hence it serves to protect the child's skin. 

Some kind of grease is needed for its removal. Its removal. 
Rendered lard and oil are the best. Cosmoline is 
not so good, as it is stififer than the other two — not 
so soluble a fat. All this cheesy substance must 
come away with the first washing, as, if left, it irri- 
tates the skin and produces sores. The most diffi- 
cult parts of the body to cleanse are the folds or 
creases. The nurse should take a piece of lard 
about the size of a walnut, rub it over the palms of 
both her hands, and then, taking the child's head 
between her hands, rub the grease thoroughly in, 
giving especial attention to the ears. A second 
piece of lard of the same size will be needed for the 
neck, shoulders, arms, chest, and back ; a third piece 
for the groin, external generative organs, and lower 
limbs. The creases and folds about the generative 
organs, especially of a little girl baby, need very 
careful cleansing. When the baby has been thus 
thoroughly gone over, she should take the corner 
of a dry sheet and rub off the grease. Many phy- 
sicians prefer not having the baby bathed after this 
greasing. It may then be dressed and laid in its 
crib. 

Should the bath be preferred, the nurse should Thebath - 



134 OBSTETRICAL NURSING. 

wrap the baby up in her flannel apron, draw the 
bath-tub toward her, and prepare the bath, filling 
the bath-tub about one-third full of warm water at 
a temperature of ioo° F., tested by the thermom- 
eter. A wall-thermometer, costing fifteen cents, 
may be obtained at any drug-store for the purpose. 
The baby is then placed in the tub, its entire body, 
excepting its head, being immersed for a moment 
or two beneath the water. The nurse should keep 
the baby from slipping from her grasp by allowing 
its head to rest against her left wrist and hand, 
while the fingers of the same hand obtairi a secure 
grasp under the child's left arm-pit. After the dip, 
the child is lifted out on to the nurse's lap again, 
where a soft, warm towel should have been spread 
for its reception. In this it should be wrapped and 
thoroughly dried. Great care must be taken to see 
that the arm-pits, groins, and other parts of the 
body where creases exist are entirely free from 
moisture. After the first bath, the child receives, 
as a rule, but a sponge-bath daily until the cord 
drops, when the daily plunge-bath may be given. 
The baby should always be thoroughly washed 
with simple warm water over the parts of the body 
soiled every time the napkin needs to be changed. 
Soap does not need to be used. Its frequent use 
would irritate the skin, and the parts can be per- 
fectly cleansed without it. 









CARE OF THE NEW-BORN INFANT. 1 35 

The use of powder in the folds and creases of the Powder. 
body is not essential. The main object is to keep 
rubbing surfaces dry, and should the nurse properly 
attend to this duty after the bath, this, with the use 
of flannel next the baby's skin, ought to be suffi- 
cient to effect the purpose. Should a powder be 
desired, some very fine, unirritating powder, such 
as lycopodium, might be used. Many of the 
scented powders contain substances which are irri- 
tating to the skin. 

After the baby has been dried, the stump of the Dressing 
cord or navel-string should be attended to. Make 
a loop of the stump, doubling it back upon itself, 
and tying it tightly by means of the ends of the 
bobbin left from the first ligature. Slit up a square 
of soft linen to its centre. ' It is well to have 
rendered this antiseptic by dipping in a bichloride 
solution 1 -1000 or 2000 before drying. Put this 
around the cord, which is slipped through the slit 
(the slit looks upward toward the child's head), fold 
over the ends, and turn the whole upon the left side. 
Some physicians will direct that no dressing be 
placed around the cord. In fact, sometimes there 
is no ligature placed around it, but it is simply well 
stripped of the blood and jelly-like substance which 
help to compose it, and thus allowed to dry. 

The placing of the loop of cord with its dressings 
on the left side of the child's body is to avoid pres- 



jelly. 



I36 OBSTETRICAL NURSING. 

sure upon the liver, which is larger than any other 
organ in the infant's body at birth, so large, in fact, 
as to extend quite down to the navel. The abdominal 
bandage is put on over the dressing to hold the 
latter in place. 

Some use antiseptic gauze in the dressing of the 
cord. A drying powder, consisting of one part 
salicylic acid and five parts starch, is an antiseptic 
application which it is often desirable to employ. 
Wharton's A clear substance exudes from the cord as it 
shrinks which wets the dressings, so that it is neces- 
sary to change the piece of linen quite often the 
first day or two. A cord kept dry by the frequent 
change of dressings will have no odor about it, and 
will drop, on an average, by the fifth day. The 
base from which the cord dropped may continue 
moist for a few days, and is best dressed by dusting 
over it a little of the starch and salicylic acid powder 
before spoken of, and placing a small compress of 
antiseptic linen or gauze over it. The navel-dressing 
is kept in place by the application of the flannel 
binder, which should be carefully adjusted, so as not 
to compress the abdomen too tightly. After the 
bandage is fastened, the nurse's hand, used flatwise, 
should be easily slipped in between the bandage and 
the baby's skin. Should safety-pins be used in 
fastening the bandage, they should be placed in front 
and not at the back, or they may cause the baby 



The binder. 



CARE OF THE NEW-BORN INFANT. 1 37 

discomfort in lying. The bandage fastened by the 
tapes, which is simply wound around the body, is 
safer on this account. 

Great importance should be given to the proper 
care of the navel, as it offers an open surface on the 
child's body through which poisonous matter may 
be taken into the blood, causing " infantile sepsis," 
or the blood-poisoning of infants. 

Before the dressing of the cord, a napkin should The napkin. 

have been laid beneath the hips of the infant, as 

there is very apt to be a free discharge of a dark, 

greenish matter from the bowels shortly after the 

birth. This is known as " meconium." It should "Meco- 
nium." 

always come away within the first twenty-four hours 
after birth, and may continue to come at intervals 
for three or four days. When it does not come 
away freely the baby may suffer considerable pain. 
A soap suppository or a small injection of warm 
water will bring about relief, causing an evacuation 
of the bowels. 

This substance is very difficult to wash out of 
napkins, hence, it is a good plan to have a soft piece 
of old muslin placed inside the napkin to catch the 
discharge. This may be burned when removed. 

The baby should be washed every time the nap- lf^f^ e 
kin needs to be changed, even if it is only wet. washin s . 

o j J and care in 

Warm water should be used. A napkin should napkins. 
never be used twice without washing. The habit 



I38 OBSTETRICAL NURSING. 

of hanging up a napkin wet with urine, allowing it 
to dry, and using it again is not only filthy, but un- 
safe, as it renders the napkin irritating to the skin 
and a source of possible septic infection. For the 
same reason a napkin should be changed as soon 
as it is wet or soiled. Though the work may be 
irksome, a nurse should not weary of it; for it is 
only by eternal vigilance that the child can be kept 
in good condition. 

Under-vest. After the application of the binder and napkin, 
the baby's under-vest, or little, long-sleeved, high- 
necked flannel shirt, should be put on. This should 
be fastened in front by safety-pins, or small, flat 
buttons or tapes. 

If the shirt is too large, folds should be made at 
the sides to make it fit better; never in the back, 
because of the ridge this would produce under the 
surface upon which the baby lies. 

socks and The socks come next and then the flannel slip, 
constituting the only other garment the baby needs. 
The petticoat with slip, or Gertrude suit, may be 
used instead, if desired. 

washing of The eyes and mouth should each be washed out 

eyes and 

mouth. w ith a separate soft piece of linen dipped in warm 

water. 
t^e U hair g T^e baby's hair, if it has any, may be brushed 

with a soft baby-brush. No comb should be used, 

as the scalp is too tender. 



CARE OF THE NEW-BORN INFANT. 1 39 

The baby should then be placed in its crib, on its 
right side, and warmly covered. The weaker the 
baby is, the warmer it will need to be kept. Stone 
jars, when filled with hot water, are nice for this 
purpose placed around the child, but care should 
be exercised not to let these bottles be placed so 
near as to cause a burn. 

In another chapter we will consider the care of 
premature infants. 

The weighing of the baby devolves often upon Weighing 
the nurse. A steelyard being provided, the nurse 
may place the nude child in a napkin, tied or pinned 
securely at the corners. This napkin may be swung 
on to the hook of the steelyard as it is held up. 
The pointer will then indicate the number of pounds 
weight. The average weight of a new-born baby 
is 3250 grammes (about seven pounds). 

In the Woman's Hospital the ordinary grocer's 
pan-scales are used, the weights being represented 
in grammes. The daily weight is taken and recorded 
on a card which hangs by a ribbon or string to 
the baby's crib, so that its daily condition may be 
carefully watched. For a comparison of the approx- 



140 



OBSTETRICAL NURSING. 



imate weights in the metric and avoirdupois scales, 
I append the following table of equivalents : — 



Relation of Avoirdupois to Metric Weights. 



AVOIRDUPOIS GRAMMES. 

POUNDS. 

1 453-592 

2 907.18 

3 1360.78 

4 1814.37 

5 2267.96 



AVOIRDUPOIS GRAMMES. 

POUNDS. 

6 2721.55 

7 3I75-I4 

8 3628.74 

9 4082.33 

10 4535-92 



Loss of 
weight for 
first few 
days. 



The 

evening 

bath. 



The crib. 



Combined 
bath-tub 
and crib. 



For the first three or four days a baby will lose 
weight, as it does not take in enough nourishment 
to make up for the loss it sustains by the newly- 
acquired activity of bowels, bladder, and skin. At 
the end of the first week the baby should weigh 
about what it did at the birth. After that it should 
gain, on an average, thirty grammes a day (about 
one ounce). 

A sponge-bath is sometimes given the baby at 
the close of the day, when its clothing is changed 
for the night ; but this is not necessary, if it has 
been properly attended to when the napkins have 
been changed. The fresh clothing at night is 
always essential. 

The baby's crib should have no rockers. All 
unnecessary swinging, rocking, and jolting of babies 
only serves to make them nervous and more trou- 
blesome to take care of. A convenient and inex- 
pensive crib and bath-tub combined, especially for 



CARE OF THE NEW-BORN INFANT. 



141 



traveling, is described in one of the numbers of 
" Babyhood," thus : " The frame is made some- 
thing like a cot-bed. Straight pine sticks may be 
used. The legs, one inch and a half square by 
thirty inches long, are crossed and pivoted in the 
middle on a centre bar. The side bars, one inch by 
two inches and thirty-six inches long, are securely 
fastened to the top of the legs. Smaller bars join 



Fig. 19. 




Home-made Bath-tub and Crib. 

the legs near the bottom to stiffen the frame. A 
piece of heavy rubber-cloth, one yard and a quarter 
long and thirty inches wide, has an inch-wide hem 
on each end for a casing, and is drawn up to eigh- 
teen or nineteen inches with heavy braid (a leather 
strap would probably be better). This makes 
the ends of the tub. Along the side bars of the 



142 



OBSTETRICAL NURSING. 



Separate 
bed from 
mother. 



Proper 
training of 
infants. 



Feeding of 
infants. 



Time. 



frame are tacked with brass-headed tacks the sides 
of the cloth, the braid (or rubber straps) being 
securely fastened to the ends. A small plait in the 
cloth at each corner, about an inch from the end, 
gives a fuller shape to hold the water (when it is in 
use as a bath-tub). The tub (or crib), when not in 
use, can be folded and set away out of sight, or it 
may be carried in the bottom of a large traveling- 
trunk when on a journey. The frame may be made 
of walnut or cherry, with turned legs, etc., if so de- 
sired. A pillow put in the tub makes a comfortable 
and portable crib for the baby. 

Children should never sleep in the same bed 
with their mothers. It is unsafe because there is 
danger of their being overlaid, and it is unhealthy 
because of the discharges, breath, etc., of the 
mother. 

A baby may be trained to be contented and 
happy as it lies in its crib. If from its earliest days 
it is taken up simply to be fed, and receive the 
necessary attentions for keeping it clean and com- 
fortable, it will not become the little tyrant a child 
develops into when foolishly spoiled by its mother. 

Babies should be fed but once in two hours 
during the day, and every three hours during the 
night, unless premature, when they can take less 
and should be fed every hour. An interval is 
necessary between the feedings in order that the 



CARE OF THE NEW-BORN INFANT. I43 

stomach may rest and be prepared properly to carry 
on its work of digestion. Hence, the habit some 
mothers have of letting babies nurse whenever they 
cry simply serves to produce indigestion, as well 
as to spoil the child.* , 

For its first nursing the baby may be put to the Cursing. 
breast an hour or two after the labor, if the mother 
is sufficiently rested. The nipples should, before 
each nursing, be carefully washed off with cold 
water: The early secretion of the breasts, known 
as " colostrum/' helps to rid the baby's bowels of 
their dark, tarry contents, as it is laxative. It is 
important that the breasts should be used alter- 
nately in feeding the infant, as this allows a longer 
time to elapse for the accumulation of milk. For 
the first day or two the baby needs comparatively 
little food. Should it seem to be hungry, however, 
and the mother unable to satisfy it, a teaspoonful 
or two of warm water or diluted peptonized cow's 
milk, prepared according to the suggestions to be 
given later, may be administered at regular intervals. 

Before and after each feeding, the baby's mouth 
should be carefully washed out with a piece of soft 
linen dipped in warm water or a saturated solution of 

* It has been observed that when the periods between nursing 
were short the milk was more condensed, a fact which throws light 
on the dyspeptic phenomena occurring in babies who are fed too 
often. — Rotch. 



144 OBSTETRICAL NURSING. 

boracic acid. This is to prevent the particles of 
milk remaining in the mouth from producing sore- 
ness by souring. 
a drink of Two or three times daily a baby should be given 

cold water. J J & 

a teaspoonful of cold water to drink, as babies suffer 
from thirst just as their elders do. The cold water 
assists, also, in keeping the bowels from becoming 
constipated. The water should be boiled and kept 
in an air-tight flask, 
insufficient Should the mother not have sufficient milk for 

milk. 

her baby, it may have the bottle every other time, 
the additional food being selected with reference to 
the child's age and powers of digestion. 
The When a mother has no milk, the best substitute 

wet-nurse. 7 

is a good wet-nurse. A wet-nurse should always 
be carefully examined by a physician, that her free- 
dom from disease may be fully determined before 
she is employed. She should be between twenty 
and thirty years of age, and have good, not neces- 
sarily large, breasts, well-shaped nipples, and an 
abundant supply of milk. The condition of her own 
child should be considered, whether it be thriving 
or sickly, and especially whether there be any 
evidence of special disease. It is well, too, to try 
to get a woman who has had more than the one 
child, as a woman who has borne several children 
has, by experience, learned to understand and 
manage babies. 



CARE OF THE NEW-BORN INFANT. I45 

The first milk that comes in the breast, and which Fore-miik. 
appears in any quantity, about the eighth month of 
pregnancy, is called " fore-milk," or " colostrum," 
from a word which means " glue." It is turbid, 
yellowish, gluey, alkaline in reaction, and easily 
sours. It differs from true milk in having a higher 
specific gravity or weight ; it also contains more 
salts and more albumen, and is more difficult to 
digest. It is laxative in its effect upon the baby's 
bowels. Physicians not unfrequently examine afor^uSing- 
specimen of this secretion under the microscope, to 
learn what the prospect is as to the mother's nurs- 
ing the child. If, in the last two months^of preg- 
nancy, the colostrum is scanty, and under the 
microscope there are but few oil globules, the 
patient will probably have poor milk and small 
in quantity. If the colostrum is abundant but 
thin, like gum water, not gluey and without 
yellowish streaks, it is probable that the milk 
will be watery and not nourishing. It may be 
either scanty or abundant. If the colostrum be 
plenty, with yellowish streaks and full of milk 
globules, the milk will be abundant and good in Duration o* 
quality. The secretion of colostrum may continue 
from six to eight days. If it continues longer it is 
a great disadvantage, and the mother may have to 
give up nursing because of the ichild's inability to 

digest the nourishment thus afforded. 
10 



secretion, 



Character- 
istics of 
human 
milk. 



Difference 
between 
human and 
cows' milk. 



Regulation 
of nursing 
to meet 
special 
demands. 



I46 OBSTETRICAL NURSING. 

Human milk should have a specific gravity of 
1028-1034. It is slightly alkaline in reaction ; that 
is, it will turn red litmus-paper blue, and it contains 
the following ingredients : — 

Water, * . 87-88 

Total solids, 13-12 

Fat,' f . 3-4 

Albuminoids, 1-2 

Sugar, 7.0 

Ash, 0.2 

—Rotch. 

It differs from cows' milk in having a higher specific 
gravity, more solids, less water, and one-fifth the 
amount of albuminoids. The milk retained longest 
in the breast — the first milk drawn by the baby at 
each nursing — is the thinnest ; the last, the richest. 
When, therefore, a baby seems to suffer from indi- 
gestion because of its mother's milk being too rich 
for it, it should take the first secretion from each 
breast at each nursing instead of drawing all the 
milk from one breast. One or two teaspoonfuls of 
water given the baby before each nursing have the 
same object. Should it, on the contrary, not seem 
to thrive because of the food not being sufficiently 
rich, the thin milk should be pumped or drawn out 
of each breast by the nurse or mother before the 

* According to the analyses of Dr. H. Leffmann the percentage of 
fat rarely reached 4, ranging between 2.5 and 3 as a rule, while the 
albuminoids were usually a fraction over 1 per cent. 



CARE OF THE NEW-BORN INFANT. 1 47 

baby is allowed to draw. The two breasts are 
estimated to contain about two ounces of milk at 
one time. * 

The question of how to increase the secretion of stimulation 

' . . _.. , . . of increased 

milk is a very important one. I he best way is by secretion. 
a judicious regulation of the mother's or wet-nurse's 
diet. There are no medicines which are entirely 
satisfactory for the purpose of stimulating the secre- 
tions. Therefore a nurse can do more than a 
doctor in this line by careful feeding of her patient. 
A mixed diet is the best for making milk. Beer 
and all kinds of liquors, as porter, etc., do more to 
fatten the mother or nurse than to make milk ; 
therefore they are to be avoided. The special diet 
for a nursing woman is laid down in another 
chapter. Good human milk should be three per 
cent, cream. f 

To determine the character of milk — human or Testing 
cows' milk — an instrument known as the lacto- 
meter, or milk-tester, may be used, aided by the 

microscope. 

. — _ . , , ■* 

* The use of from 1-5 drops of cod-liver oil, according to the age 
of the child, given three times daily, has been found to be a valuable 
supplement to the food when a mother's milk lacks richness. — Dr. 
A. E. Broomall. 

f As a general rule, the amount of fat may be increased by in- 
creasing the amount of meat in the diet, and the amount of albumen 
decreased by moderate exercise. Too little fat and too .much 
casein make poor milk — Rotch. 



148 



OBSTETRICAL NURSING. 



The lacto- 
meter. 



Determina- 
tion of 
proportion 
of cream. 



Fig. 20. 




The lactometer consists of a 
cylindrical glass vessel, or beaker, 
which should contain the milk 
to be tested, and a specific gravity 
glass, which is to be floated in the 
liquid. This glass is graduated 
and marked at certain points with 
certain letters and figures. Thus, 
W, P., and F. The W. stands 
for "water," P. for "pure," and 
F. for " fat." Between the W. and 
P., at different points, are the 



fractions, 



%> % 



%- 



Should the 



weighted glass sink in the liquid 
so that the surface of the liquid 
reached the mark W., the liquid 
tested w r ould have the same specific gravity as water. 
Should the surface of the liquid reach the mark *^, 
if it is milk that is tested, it would be y milk and 
y water. If the mark ]/ 2 is touched, it is y 2 water 
and y 2 milk. In this way the adulteration of the 
milk with water is detected. Should the level of 
the liquid stand at P., we would have pure milk. 
Pure cream would raise the weighted glass so that 
the level of the liquid would stand at F. An ordi- 
nary urinometer may be used to obtain the specific 
gravity of milk in a similar way. Dr. Louis Starr 
suggests a good way to discover the proportion of 



CARE OF THE NEW-BORN INFANT. I49 

cream in any given sample of milk : A narrow 
piece of paper, four inches long, is divided in its 
upper half inch by cross-markings into twelve equal 
parts. This paper is then pasted on the beaker of 
the lactometer with the marked portion uppermost, 
the lower edge touching the bottom of the beaker. 
Enough milk is then poured in to come just to the 
top of the paper, and the whole set aside for 
twenty-four hours. The cream rises and appears 
as a yellow layer at the top. This layer should 
have the depth of ten or twelve spaces, as marked 
on the paper. 

On examination under the microscope, if there ^ cr j°" ex 
are but few oil globules in a specimen of milk, and of^fk on 
if these oil globules be small, the milk is poor. On 
the other hand, if the oil globules in milk are too 
large, this becomes a cause for its indigestibility. 

Should menstruation begin with a nursing Effect of 
mother, the milk may be so affected as to disagree tbn on 
with the child. Ordinarily, the menstrual flow does 
not recur until the eighth month after delivery. 
The appearance of the flow need not lead to a ces- 
sation of nursing, unless the milk should seem to 
disagree with the child. The character and quantity 
of the milk is impaired by deep or violent emotions; 
thus, anxiety, fear, anger, etc., will greatly detract 
from a woman's ability to be a good wet-nurse. 



menstrua- 
tion on 
secretion. 



ISO 



OBSTETRICAL NURSING. 



Effect of 
pregnancy 
on 
lactation. 

Artificial 
feeding. 



Character- 
istics of 
cows' milk. 



Analysis of 
human and 
cows' milk. 



Pregnancy always deteriorates the character of milk 
and is an indication for weaning a nursing child. 

When the mother's milk utterly fails, and a wet- 
nurse cannot be had, hand-feeding becomes neces- 
sary. For this purpose diluted, sterilized cows' 
milk may be used. 

Cows' milk has a specific gravity of 1.029. The 
milk obtained from stall-fed cows gives an acid re- 
action; that from pasture-fed cows a less acid reac- 
tion. Could the latter be obtained directly from 
the cow its reaction would be slightly alkaline, as 
with human milk. An analysis of the same quan- 
tity of woman's milk and cows' milk is reported as 
yielding the following results : — 



woman's milk 

Water, 87.88 parts. 

Total solids, . .12.13 



Fat, .... 
Albuminoids, 
Milk-sugar, . 
Ash, . . . . 
Bacteria . . 



4.00 
1. 00 
7,00 
0.2 
not present. 



cows' 


MILK 


86.87 P arts 


13.14 


a 


4.00 


a 


4.00 


a 


4.5 


a 


0.7 


a 


present. 



Points of 
difference. 



The woman's milk for this analysis was obtained 
directly from the breast. The cows' milk was, as 
it is ordinarily obtained in cities, about twenty-four 
hours old. 

By an examination of this analysis, it will be seen 
that the proportion of coagulable substances of 






CARE OF THE NEW-BORN INFANT. 1 5 I 

cows' milk is much greater than in human milk. 
This is where the difficulty in its digestion lies. 
Casein of human milk coagulates in light curds; in 
cows' milk in firm, hard curds. 

The kind of food required by different babies will £ f u f ^ y 
vary with their constitutions. As a rule, a mother's J^g^ 
milk is the best food for her child, and makes a good 
gauge to start from in the preparation of an artificial 
food to take its place or act as a supplement when 
there is an insufficient supply. If, therefore, a care- 
ful analysis is made of a mother's milk and a 
mixture prepared which shall, so far as possible, 
contain the same constituents in the same propor- 
tion, we may hope that the baby will thrive on it. 
A steady increase in the baby's weight will be the 
best index by which we can judge of the nutritive 
qualities of the food it is taking. 

For the first four or five months of its life, a child 
should gain on an average twenty to thirty grammes 
(about one ounce) daily. For the remainder of the 
first year of life, a daily gain of from ten to fifteen 
grammes will mark satisfactory progress. 

In the comparatively few cases in which a Necessity 
mother's milk does not appear to have proper nutria analysis. 
tive or digestive properties, it should be similarly 
examined to discover in what direction the 
deficiency lies, and the artificial food should be pre- 
pared so as to supply the lack. The nutritive con- 



152 



OBSTETRICAL NURSING. 



Prepa- 
ration of 
cows' milk. 



Quality of 
cream. 



stituents of milk are the albuminoids, fat, and^milk- 
sugar. 

Cows' milk contains about four times the quantity 
of albuminoids found in human milk, so that it 
requires to be diluted with four times as much 
water to represent the same percentage of 
albuminoids. Since the amount of fat in human 
and cows' milk are about equal, this dilution would 
greatly decrease the percentage of fat. Also since 
cows' milk contains a much smaller quantity of 
sugar of milk than is found in human milk, the same 
dilution would be greatly deficient in sugar. 

In preparing a mixture from cows' milk, there- 
fore, which may correctly represent human milk, 
fat, in the form of cream, and sugar of milk must be 
added. 

Cream varies very much in richness, hence it 
is desirable to know what percentage of fat is 
represented by the cream used in compounding a 
mixture. A chemical analysis of the cream is 
necessary for accuracy of result in such determina- 
tion. It has been suggested that to prevent too 
much variation in the percentage of fat, the cream 
should be obtained of the same person from milk 
that has been allowed to stand each day for the same 
length of time and in the same temperature. 

A mixture made up according to the following 
rule probably most nearly resembles the average 



CARE OF THE NEW-BORN INFANT. 1 53 

human milk. To make one pint of the mixture for 
use in twenty-four hours, take milk and cream 
(twenty per cent.) as soon as it comes in the morn- 
ing, and mix as follows : — 



Milk, ' fgij 

Cream, f*^ iij 

Water, f g x 

Milk sugar, 3 63 



Put in a flask in the steamer and steam for twenty 
minutes ; then remove the flask from the steamer, 
and when still slightly warm add lime-water f§j. 
Place on ice, and give the proper amount at the 
proper feeding time. (Rotch) 

The object in steaming the mixture is to sterilize 
it, for human milk is sterile, and for that reason 
more digestible than cow's milk — which, although 
sterile while in the udder, becomes contaminated as 
it is placed in vessels and transferred from place to 
place. It is believed by some that this steaming or 
boiling of milk has a tendency to decrease its 
digestibility. The danger from this source, how- 
ever, is probably much less than that which would 
arise from the presence of germs in the milk, such 
as have been shown to exist. " Fractional steriliza- 
tion/' the heating of milk in a water-bath for several 
days in succession up to a more moderate degree 
of heat than that required for complete sterilization, 



154 OBSTETRICAL NURSING. 

is said not to have the same effect in decreasing the 
digestibility of milk. 

Lime water is added to make the mixture alka- 
line, all human milk being slightly alkaline. 
It should not be placed in the flask before 
boiling or steaming, because experimentation has 
shown that the lime undergoes some change in the 
process of boiling which causes a discoloration of 
the milk and the deposit of a sediment. Experi- 
ment has shown that water is the most efficient 
diluent to be employed in making these mixtures, 
as it gives a much finer curd with acids, when so 
used, than can be obtained by an admixture with 
barley-water or any of the prepared foods. 

Having thus determined by analysis the quality 
of the food required for an infant, the quantity must 
be determined and frequency of feeding. 
Quantity As to quantity, the observations made by Dr. 

of food. A J * 

Ssnitkin, of St. Petersburg, have led to the formula- 
tion of a rule by which one one-hundredth of the 
baby's weight should be taken as the figure with 
which to begin the computation, and to this should 
be added one gramme for each day of life. 

A table prepared by Dr. Rotch, of Boston, has 
arranged in very convenient form the quantity and 
intervals of feeding for the first year of a child's 
life:— 



CARE OF THE NEW-BORN INFANT. 1 55 

GENERAL RULES FOR FEEDING. (Rotch.) 



Age. 


Intervals 

of 
Feeding. 


Number 

of 
Feedings 

IN 

24 Hours. 


Average 

Amount at 

Each Feeding. 


Average 
Amount in 
24 Hours. 


ist week. 


2 hours. 


10 


1 ounce. 


10 ounces. 


1-6 weeks. 


"2% hours. 


8 


1^-2 ounces. 


12-16 ounces. 


6-12 weeks and 

possibly 
to 6th month. 


3 hours. 


6 


3-4 ounces. 


18-24 ounces. 


At 6 months. 


3 hours. 


6 


6 ounces. 


36 ounces. 


At 10 months. 


3 hours. 


5 


8 ounces. 


40 ounces. 



Another table arranged by Dr. Rotch shows the 
amount required at each feeding, according to the 
weight of the child. 

DETERMINATION OF AMOUNT OF FOOD BY WEIGHT 
IN CASES OF SPECIAL DIFFICULTY 



Initial 




Each Feeding. 




Weight. 


EARLY DAYS. 


at 15 DAYS. 


AT 30 DAYS. 


3000 
grammes. 


30 grammes. 
(About 1 ounce.) 


30 + 15=45 grammes. 
(About i]/ 2 ounces.) 


30+30=60 grammes. 
(About 2 ounces.) 


4500 
grammes. 


45 grammes. 
(About 1% ounces) 


45 + 15=60 grammes. 
(About 2 ounces ) 


45+3o=75 grammes. 
(About 2% ounces.) 


6000 
grammes. 


60 grammes. 
(About 2 ounces.) 


60 + 15=75 grammes. 
(About 2% ounces.) 


60+30=90 grammes. 
(About 3 ounces.) 



I56 OBSTETRICAL NURSING. 

A new-born infant's stomach holds about \*4 
ounces. The average daily quantity of food re- 
quired for the first 2-3 months is 20 ounces ; after 
3 months, 23 ounces ; after 4 months, 27 ounces ; 
6-12 months, 30 ounces. The child's appetite, 
however, if it be healthy, is a good gauge. During 
the first month 1^ ounces of the prepared cow's 
milk may be given at each feeding, and twelve 
feedings given daily. 

Peptonized food diluted has been employed with 
great success by some physicians where the diges- 
tive powers in early childhood seemed at fault. 
The following formula may be used for the 
purpose : — 

Into a clean quart bottle put one measure, or five 
grains, of extractum pancreatis (Fairchild's), and 
one measure, or fifteen grains, of bicarbonate of soda, 
and a gill of cold water; shake, then add a pint of 
fresh cold milk, and shake the mixture again. 
Place the bottle in water about iio° or 1 1 5 °, or so 
hot, that the whole hand can be held in it without 
discomfort for a minute. Keep the bottle there for 
twenty minutes. At the end of that time put the 
bottle on ice to check further digestion and keep the 
milk from spoiling. 

If heat cannot be conveniently provided, after 
the ingredients have been thoroughly mixed and 



CARE OF THE NEW-BORN INFANT. I 57 

shaken, the bottle may be placed on ice and allowed 
to stand for an hour before it is used. 

It must be remembered that peptonized milk 
cannot be sterilized or it becomes unfit for food — 
the process of digestion being carried so far as to 
curdle the milk and render it extremely unpalatable. 

If an additional aid to the digestion should be 
necessary, a little pepsine may be given to the child 
just before each feeding, or the pepsine may be 
placed in the nursing bottle just as the child takes 
it. Pancreatic extract and soda, if used, will need 
to be given about an hour after the meal. 

A preparation of peptonized milk, which has 
been much used by Dr. Broomall, is the following : — 

Peptonized milk, 6 tablespoon fuls 

Milk-sugar, ^ teaspoonful 

Barley water, 2 tablespoonfuls 

Lime water, ..." 1 tablespoonful 

Another favorite formula in Philadelphia is that 
of Dr. Meigs, known as Meigs' Food: — 

2 parts cream. 

1 pait milk. 

2 parts lime water. 

3 parts su^ar water. 

The sugar water is prepared by putting eighteen 
tablespoonfuls milk sugar to a pint of water. 

Dr. Louis Starr gives a very useful dietary for 
infants, which has also met with great success. 



158 OBSTETRICAL NURSING. 

Those formulae which especially concern the 
obstetric nurse are as follows : — 
Diet for first week : — 

Cream 2 teaspoonfuls 

Whey,* . . 3 teaspoonfuls 

Water (hot), 3 teaspoonfuls 

Milk sugar, }{ teaspoonful 

for each portion ; to be given every two hours, 
from 5 a. m. to 11 p. m., and in some cases once or 
twice at night, amounting to twelve fluid ounces of 
food per day. 

Diet from the second to the sixth week : — 

Milk, I tablespoonful 

Cream, 2 teaspoonfuls 

Milk sugar, % teaspoonful 

Water, 2 tablespoon fuls 

for one portion, to be given every two hours, from 
5 a. m. to 11 p. m., amounting to seventeen fluid 
ounces of food per day. 

The proportion of milk in the mixture and the 

quantity given at one time are carefully increased 

during the succeeding weeks. 

un-^offood The temperature of the food should be 99 Fahr. 

It is a great mistake to make it too hot. The 



* Whey is made by adding three teaspoonfuls of wine of pepsine 
to a quart of warm, fresh milk, and placing the mixture near the fire 
for two hours. The curd is removed by straining through muslin. 



CARE OF THE NEW-BORN INFANT. I 59 

warming of the child's food should be accomplished 
by setting the filled nursing bottle into a vessel of 
hot water. It may be heated quickly over a gas 
jet by setting the bottle into a tin mug filled with ■ 
water and holding it over the flame. Suggestions 
concerning the modification of food, when milk thus Artificial 
prepared does not agree with infants, will be given '„ ppf e S m ent 
in another chapter. When the mother's supply of£ i £ mher ' s 
milk is scanty, and the baby cries with hunger, oc- 
casional meals of the above preparations will be a 
great aid in its management. 

In the artificial feeding; of infants in the Woman's sterilization 

r of milk. 

Hospital, sterilized milk is used for the various pre- 
parations employed, as a rule. 

By sterilizing milk is meant the process of de- 
stroying any poisonous matter which may have 
found its way into it. Exposure to the atmosphere 
and admixture with particles of dust and dirt during 
its transportation, with want of care as to cleanliness 
of vessels, etc., in which the milk is kept, induce 
certain fermentative changes, which cause it to sour 
and to produce digestive disturbances. Steriliza- 
tion destroys the germ of poisonous matter by sub- 
jecting the milk to a high degree of heat under 
pressure. Many forms of apparatus have been Apparatu^ 
devised for this purpose. The one in use at the tion - 
Woman's Hospital is called Blair's Sterilizing 



i6o 



OBSTETRICAL NURSING. 



Apparatus.* It is very similar in general construc- 
tion to the one devised by Dr. Louis Starr and 
shown in the cut. This consists of an oblong case 

Into this a movable 



of tin fitted with a tight cover 



Fig. 21. 




Sterilizer (Dr. Louis Starr).f 

wire basket, holding ten bottles, is placed. The 
bottles are of flint glass, graduated and fitted with 
rubber corks having a glass plug fitted into an 

* Arnold's steam sterilizer has also been employed more recently 
with very satisfactory result. By this arrangement the milk is 
steamed instead of boiled. 

f " Hygiene of the Nursery." 



CARE OF THE NEW-BORN INFANT. l6l 

opening in their centres. The rules for using the Rules for 

.... r sterilizing 

sterilizing apparatus are as follows : — milk. 

ist. Cleanse the bottles thoroughly. 

2d. Fill each with the milk you wish to use, put 
in the rubber cork without the glass plug (this 
leaves a small opening in the rubber cork) ; set 
the bottle in the basket, then in the boiler ; fill the 
boiler with water almost as high as the milk in the 
bottle ; boil about ten minutes, or, better, as Dr. 
Starr expresses it, " until the expansion that pre- 
cedes boiling has taken place in the milk ;" then 
put the glass plugs tightly in each stopper and boil 
for fifteen or twenty minutes more. Should the 
rubber corks incline to come out during the second 
boiling, put them in firmly. 

3d. Keep in a cool place till needed for use. 

4th. When to be used, place a bottle of the milk 
thus prepared in the tin mug which accompanies 
the apparatus. Pour hot water in the mug until it 
is as high as the milk in the bottle. Heat the milk 
to the temperature desired for feeding (99 ° Fahr.) ; 
remove the rubber cork and put on rubber nipple, 
and feed. 

5th. Cleanse each bottle immediately after the 
milk in it is used. Do not keep milk in a bottle 
that has had some used out of it. 

6th. If the steaming process is preferred, place 

the basket, without the bottles, in the boiler, fill 
11 



1 62 



OBSTETRICAL NURSING. 



Length of 
time 

sterilized 
milk will 
keep. 



Conveni- 
ence when 
traveling. 



Nursing 
bottles and 
rubber 
nipples. 



with water up to but not above the bottom of the 
basket, place the bottles in the basket, and proceed 
as before. 

Milk should be sterilized as soon as possible 
after it has been served each morning. Each bottle, 
when emptied, should be thoroughly washed. If 
the whole contents of the bottle are not used after 
it is opened, the remainder must not be used for 
the child nor allowed to remain in the bottle. 

Milk sterilized in this way will keep for days 
without spoiling, as it is hermetically sealed and 
has been deprived of all unhealthy germs. Dr. 
Louis Starr makes the assertion that it will keep 
for eighteen days if the heating is continued for 
thirty minutes. 

Sterilized milk is useful when traveling, as it may 
be carried without any trouble, the difficulty ol 
obtaining fresh milk being thus overcome. Its use 
makes the management of babies during the heat 
of summer much easier. 

A word remains to be said concerning feeding 
bottles and rubber nipples. 

The bottle should be of clear glass, with a 
rounded bottom, of a shape convenient to clean, so 
that no particles may cling about corners which 
cannot be reached, serving as a source of trouble 
afterward. The graduated bottle is very nice, as it 
enables the quantity of each of the materials used 



CARE OF THE NEW-BORN INFANT. 



163 



in the preparation of the feeding to be mixed 
directly in the bottle, instead of being first measured 
out in a graduate. 

Feeding-bottles with India-rubber tubes are very 



Fig. 22. 




Graduated Nursing Bottle (Dr. Louis Starr), 



objectionable, for the tubes are difficult to keep 
clean, and a drop or two of milk left behind will 
often be sufficient to turn the next supply sour, 



164 



OBSTETRICAL NURSING. 



causing the infant much sickness and suffering. 
Nurses are prone, also, with these tubes, to place 
the baby in its crib with the bottle of milk by its 
side and the nipple in its mouth. The heat of the 
child's body tends to sour the milk, the liquid may 
run low, and the child suck in considerable air. 
The neck of the bottle should always be kept filled 
with the liquid while the child is nursing, hence 
the position of the bottle must be changed. A 
feeding-bottle fitted with a rubber nipple requires 
to be held in the nurse's hand during the feeding, 
and is, on that account, to be preferred. There 
should always be two nursing-bottles for each baby, 
one being kept under water or filled with a soda 
solution' while the other is in use. Immediately 
cleaning of a ft e r the meal the bottle should be cleaned, etc. 

nursing ' 

bottle. Scalding water should be used, and then the bottle 
filled or placed beneath a solution of bicarbonate 
of sodium — ordinary baking soda— a teaspoonful 
to the pint, until it is again needed, when the soda 
solution should be emptied out and the bottle thor- 
oughly rinsed with cold water. Some use salicyl- 
ate of sodium for the cleansing solution in prefer- 
ence to the bicarbonate. 

Two nipples should be in use at the same time, 
being used alternately, and no nipple should be 
used longer than two weeks. A soft rubber nipple 
of conical shape is the best, because it can be more 



Rubber 
nipples. 



CARE OF THE NEW-BORN INFANT. 1 65 

readily cleaned. The black rubber is generally 
softer than the white, and is to be preferred. The 
opening at the top of the nipple should not be too 
large, as that would permit the milk to flow through, 
when the suction produced by the child's mouth is 
necessary to the food being taken in a natural man- c1 
ner. So soon as the meal is over, the nipple should oi 
be removed from the bottle, brushed with a stiff 
brush, wet with cold water on the outside, then 
turned inside out and similarly brushed on its inner 

Fig. 23. 



eansing 
rubb< 
nipple. 




Rubber Nipple (Starr). 

surface. It should then be put in cold water and 
allowed to stand until wanted. A nurse's sense of 
smell should be keen enough to enable her to 
detect the slightest sourness about a bottle or 
nipple. 

The baby should be fed slowly — taking often ten Tim ? , 

J J ■■ o required 

to twenty minutes for its meal. Sucking from an for feedin s- 
empty bottle should never be permitted. Pre . 

It is a bad plan to make the whole day's supply^*"™ 



1 66 OBSTETRICAL NURSING. 

of food in the morning, unless the facilities for 
keeping it are such as to insure against its spoiling. 
When a sterilized preparation is used, it is desirable 
to have the whole amount prepared at once in a 
number of small flasks, each containing the amount 
for one feeding. 

The sterilization of the quantity of milk to be 
used during the day may all, however, be accom- 
plished at one time. 

improvised In lieu of the regular sterilizing apparatus, milk 

a P e pLratul may be similarly boiled in a water-bath formed by 
any ordinary boiler, the milk being contained in a 
glass fruit-jar with a screw lid. After coming to 
the boiling-point, or boiling about two minutes 
without the lid, the latter may be screwed on and 
the boiling continued. A better way is to put the 
jar in a colander placed over a steaming tea-kettle 
in place of the lid. The milk should be allowed 
to boil in the open jar for about two minutes ; the 
jar lid then being screwed down, it should steam 
for twenty minutes. 

Free Besides good food and sufficient warmth, babies 

need an abundant supply of fresh air, hence the 
room should be kept pure and wholesome. 

The daily In fine weather, after the first three or four weeks, 
a baby should be carried out in the open air every 
day for a time. . 

It is preferable to carry the child in the arms, 



airing. 



CARE OF THE NEW-BORN INFANT. 1 67 

rather than to place it in a baby-coach. It can 
thus be kept warmer, and any evidence of chilling 
will be sooner detected by the appearance of the 
baby's face. 



CHAPTER XII. 



MANAGEMENT OF THE LYING-IN. 



Rest. Immediately after the delivery it is necessary 

that the patient should have rest. The room 
should be kept exceedingly quiet and the shades 
drawn down so as to subdue the light. 
Light sleep. The patient may be allowed to sleep, but the 
nurse, during this time, should watch her very 
carefully, as there is a liability to bleeding when 
the sleep is too deep, owing to the general relaxa- 
tion induced by sleep. She should draw the bed- 
clothes up at one side from time to time, to see 
how much blood is lost. 

There should be no unpleasant smell about a 
confinement room, plenty of fresh air should be 
allowed to enter, and all discharges should be at 
once removed from the room. 

While the patient sleeps, and after the child has 
received proper attention, the nurse should place 
the soiled sheets, towels, and all articles stained 
with blood in cold water to soak. 

The afterbirth, also, should be disposed of. If 

1 68 



Absence of 
odor. 



Attention 
to soiled 
clothing. 



Care of 
afterbirth 



Duties of 
nurse as 



MANAGEMENT OF THE LYING-IN. 1 69 

in the country, it should be buried in a hole dug in 
the yard, two or more feet deep. It should never 
be thrown down a water-closet or privy. In the 
city it is best to burn it at night. It may be put in 
the range or stove and well covered up with coals. 
Clots of blood may safely go down the water-closet, 
as they readily dissolve. 

To return to the soiled clothing left after a con- 
finement — though a trained nurse will not often be^ffhuig 
called upon to attend to the washing of these 
articles, there will be times when it would be better 
that she should do so, both to save the patient 
expense and trouble and to prevent their lying 
about too long. At any rate, she should know 
how it should be done. Should the clothing be 
put to soak before the blood has dried into it, and 
allowed to remain for a few hours, the water being 
changed as often as needed, the washing will not 
be difficult. 

As a rule, it is not best that a nurse should leave 
her patient or the baby long enough to attend to 
this wash, hence it is advisable to have it put out 
or done by some one else in the house. The 
soaking ought, however, always to be attended to 
by the nurse, because it facilitates the subsequent 
washing. 

In the after-care of the patient the nurse should 
attend to the washing of the mother's and baby's 



170 



OBSTETRICAL NURSING. 



Visitors. 



Puerperal 
mania. 



Food of 
lying-in 
patient. 



Dietary of 
the lying-in. 



napkins. She should, if needed, wash the baby's 
flannels and slips. 

For a week a newly-confined patient should see 
no visitors. Even the husband should not remain 
in the room long at a time. No painful or exciting 
news should be communicated to the patient, as a 
distressing form of mental trouble to which lying- 
in women are prone may be thus induced. This 
is known as " puerperal mania/' 

After the patient rouses from her first sleep she 
is generally hungry. The nurse should have 
learned from the physician before he left what he 
would prefer her having. A cup of warm milk or 
tea — not too hot — may be given directly after the 
confinement when ether has not been taken, and 
this followed in three or four hours by a light meal, 
as toast and tea or gruel. With regard to the diet 
of the lying-in, nurses must be prepared to follow 
the rules of the physicians for whom they work. 
Some physicians allow considerable variety in the 
food from the beginning. 

The following directions concerning the diet are 
given to the nurses of the Woman's Hospital : <4 It 
should be remembered in the diet of the lying-in 
woman, that the amount of liquids must be limited, 
not only until after the secretion of milk, but 
also until the supply of milk adapts itself to the 



MANAGEMENT OF THE LYING-IN. I/I 

demand, for the first five or six days after the 
confinement. 

As soon as the patient is made comfortable after 
the birth, she should have a cup of warm milk or 
weak tea or warm water and milk. 
First meal time : Plate of milk toast or bowl of oat- 
meal gruel, or saucer of wheat germ or boiled rice. 
Second meal : Cup of weak tea or warm milk, dry 

toast, or milk toast, or water toast, or soda 

crackers soaked in hot milk. 
Third meal: Saucer of oatmeal mush^or wheaten 

grits, with a cup of tea or warm milk, with 

Graham biscuit or dry toast. 
Forenoon, afternoon, bedtime : Lunch, a cup of 

warm milk, with a piece of dried bread or zwie- 
back. 
Second Day. — The same as above. 
Third Day. — The same, with the addition of stewed 

apples or baked apples for supper. 
Fourth Day. — Breakfast: Soft-boiled egg f dried 

bread, stewed fruit, and cup of milk or weak tea. 
Dinner : Plain beef or mutton-broth, dried bread, 

and farina or junket. 
Supper : Baked apples or stewed prunes, saucer of 

wheat germ and zwieback. 
Fifth Day. — Breakfast : Cup of weak coffee or 

cocoa, mutton-chop, oatmeal mush, dried bread, 

and a sweet orange or ripe apple. 



172 OBSTETRICAL NURSING. 

Dinner : Beef or mutton-broth or oyster-stew, 
baked potato, stewed tomatoes, dried bread, farina, 
junket, or rice. 
Supper : Stewed fruit, Indian-meal mush, and zwie- 
back. 
Sixth Day. — Ordinary plain diet, avoiding salads, 
sour fruit, fried or highly-seasoned meats, fancy 
desserts, or sweets of any kind." * 
This holds good of all subsequent meals. The 
above dietary will require to be modified when 
special indications arise. Should the patient's tem- 
perature rise to ioo° Fahr., or above, she should 
be kept on liquid diet, as milk and beef-tea alter- 
nately every two hours. 

As liquids favor the secretion of milk, liquid food 
should constitute a large proportion of the nourish- 
ment taken by nursing women throughout the 
lying-in, provided there is not a tendency to over- 
secretion. The diet should be plentiful and nutri- 
tious, but selected carefully with reference to its 
digestibility. As the patient must remain inactive 
for some time, it will not do for her to eat the 
starchy vegetables, pastry, or warm breads, for all 
these require very active powers of digestion. 

A nurse should thoroughly understand the art of 
cooking, and be able to provide her patient with 

* Dr. Anna E. Broomall. 



MANAGEMENT OF THE LYING-IN. 1 73 

palatable and nutritious dishes, daintily and prettily 
served on a tray, until, with the physician's consent, 
she takes her place at the family table. Even then 
a nursing woman will need to receive some nour- 
ishment, as gruel, beef-tea, milk etc., between the 
regular meals, for she must not only .provide for 
herself but her child. 

The lying-in lasts six weeks. During this time Duration of 

J fe m ^ lying-in. 

the organs of generation are returning so far as 
possible to their former condition. It is important 
that the patient should have rest, and for at least £enttobed 
two weeks of this time should be in bed. 

The process of changes by which the womb 
shrinks to its normal size is known as" involution." t ion/° u ~ 
This process is favored by the patient lying as 
much as possible on her back, so that the womb 
does not incline too much to one side or the other. 
The patient may be carefully propped up a little by 
pillows on the third or fourth day so that she shall 
be in a semi-reclining position. This facilitates the 
drainage of the uterus. Care must be taken not to 
permit her to move herself too much, as a hemor- 
rhage may be thus started. 

The discharges of the mother continue about two « Lochia." 
weeks, and they are called the " lochia." For the 
first twenty-four hours they are blood ; the second 
and third day, watery blood ; from the fourth to the 
sixth day they have a greenish-yellow coloration, 



174 



OBSTETRICAL NURSING. 



and from the tenth to the twelfth day they become 
white. This white discharge may continue for a 
long time after the confinement. The character of 
the discharge will indicate the process of involution, 
hence the physician should see daily the napkins 
or dressings removed from the patient. Soiled 
napkins and dressings should never be kept in the 
patient's room, but in some closed vessel, as a clean 
chamber or a slop jar, with a close-fitting lid, in 
another room. The existence of the least odor 
about the discharge should at once be brought to 
changes of the physician's attention. If napkins are used, they 

napkins and L J x ' J 

dressings. w ju ne ed to be changed during the first day about 
every two hours, sometimes oftener, the second 
and third day about every three hours, the fourth 
and fifth day every four hours, until, by the tenth 
day, about three changes are sufficient. The anti- 
septic dressings are changed, as a rule, every three 
hours until the discharge ceases. If it be very 
scant, a change once in six hours may be sufficient. 
These antiseptic dressings should be burned. The 
napkins should be soaked in cold water until the 
blood is well out of them, and then thoroughly 
washed and boiled. The boiling is sufficient, if 
properly done, to render them aseptic, but, as an 
additional precaution, they may be wrung out in 
oYn^pklns a 1-2000 bichloride solution before drying. The 
dressings, patient should be washed off each time the napkin 



MANAGEMENT OF THE LYING-IN. 1 75 

is changed with a warm antiseptic solution, as 
1-4000 of the bichloride of mercury. Care should Cleansing 

.of patient. 

be taken not to irritate the parts. Instead of -using 
a soft cloth to wash off the parts, the water may be 
poured in a small stream over them, and a soft, dry 
cloth pressed gently over them to remove all mois- 
ture. Especial care should be taken where there 
are stitches not to pull upon them in any way. 

One daily washing of the entire body is, as a rule, Bathing, 
desirable. The doctor's advice, however, should 
be asked concerning the matter. This wash, when 
given as a sponge-bath, need not exhaust the 
patient, nor cause too much movement of her body. 
The patient should never feel chilly during this 
bath ; should she do so, the bath must at once be 
stopped. The bath should, of course, be given under 
cover. The increased activity of the skin neces- 
sitates especial cleanliness, and the daily bath is 
found, when properly given, to be very refreshing. 
Frequent changes of bed and body clothing, too, 
are necessary — the body clothing, if possible, daily 
until the discharges cease. 

The bladder is frequently paralyzed after confine- The 
ment, as a result of the pressure to which it has 
been subjected during the birth. When it is filled 
beyond a certain limit, it may respond to the irrita- 
tion and a little urine be voided, but the bladder not 
be emptied. The nurse can tell by the amount 



I76 OBSTETRICAL NURSING. 

passed whether the patient has probably emptied 
the bladder or not. The secretion of urine early in 
the lying-in is very free, hence the quantity passed 
should never be scant. By placing the hand over 
the lower part of the abdomen, the bladder may be 
felt as a soft tumor on one or the other side, above 
the pubic bone, the womb being felt as a harder 
mass pushed to the opposite side. 
Use of The catheter should not be used without the 

catheter. 

physician's sanction, but a nurse should never forget 
to ask very particularly about this matter before he 
leaves the house after the delivery. It is generally 
undesirable to allow a patient to go longer than six 
hours without freely emptying the bladder. As 
over-distention of the bladder prevents proper con- 
tractions of the womb, and as a relaxed womb is a 
frequent cause of after-pains, it is best to have the 
bladder quite frequently emptied during the first 
twenty-four hours. Hence, if the catheter is per- 
mitted to be employed, it may be well to use it 
about three hours after delivery for the first time 
(the physician having used it, if necessary, immedi- 
ately after delivery). Its subsequent use should be 
limited to about once in six hours, unless its more 
frequent use is demanded by the interference with 
the contractions of the womb caused by over 
distention of the bladder. The patient should be 
encouraged to make a trial to urinate as soon as 



MANAGEMENT OF THE LYING-IN. 1/7 

possible, so that the use of the catheter may be en- 
tirely dispensed with. Great care is necessary in Precautions 

.in use of 

the use of the catheter: ist, to see that the instru- catheter] 
ment is thoroughly clean and kept clean ; 2d, to 
see that none of the vaginal discharges are carried 
into the bladder during its introduction ; 3d, to do 
no injury to the mother's parts or give her needless 
pain. 

The instrument, or silver catheter, should be 
thoroughly boiled if there is any doubt about its 
being aseptic. When withdrawing it the outer 
extremity should be kept lowered, so that all the 
urine remaining may flow out from it, and no sedi- 
ment settle in the closed end to become a source of 
contamination at some future time. It should then 
be thoroughly washed in hot water, which should 
be allowed to flow through it from the inner toward 
the outer extremity, carrying out any sediment from 
the urine, and it may be. kept during the intervals 
of its use in an antiseptic solution — a two per cent. 
solution of creoline or carbolic acid. To prevent 
the carrying of the vaginal discharges into the 
urethra the parts should be carefully washed off 
with an antiseptic solution, either by irrigation or 
by means of a soft cloth, before the insertion of the 
catheter. 

The index finger of the nurse's right hand (which Method ot 

should each time be thoroughly cleansed in an catheter. 
12 



178 OBSTETRICAL NURSING. 

antiseptic solution) should be slipped into the vagina 
as far as the second joint, and made to follow the 
anterior vaginal wall down in the median line to the 
vaginal entrance, when a little elevation of the 
surface will be felt, immediately above which the 
orifice of the urethra is to be found. If the finger 
be held with its palmar surface upward and resting 
lightly upon this elevation, the finger being held 
horizontally, a catheter * slipped along it will enter 
the small orifice of the urethra. Should the 
extremity of the catheter seem to meet with any 
obstruction after its entrance into the urethra, a 
slight withdrawal and rotation of the instrument 
will generally carry it in. The use of the catheter 
need not involve the slightest exposure of the 
patient. A cultivated touch will enable a nurse to 
do better than by sight in its use. Hence, it may 
all be done under cover. 
SSm in F° r ^ e ^ rst twenty-four to forty-eight hours after 
delivery, particularly if the labor has been a difficult 
one, there is a considerable swelling of the parts, 
which offers a mechanical hindrance both to 
voluntary urination and the passage of the catheter. 
Great gentleness is therefore required in the neces- 
sary manipulations. This swelling in an ordinary 
case should disappear at the end of twenty-four to 

* Glass catheter. 



urination 

from 

oedema. 



tion. 



MANAGEMENT OF THE LYING-IN. 1 79 

forty-eight hours. Should the inability to urinate 
persist after this, it is in all probability due to the 
condition of paralysis before referred to. Especial 
medication by the physician, as the use of muscle 
and nerve tonics, fomentation over the lower part 
of the abdomen and external generative organs, hot 
water in a bed-pan, placed beneath the patient's hips, 
may serve to stimulate voluntary urination. The 
attempt to induce this should be made each time 
before a resort to the catheter, as the constant use 
of the latter will only keep up the difficulty. 

As a rule, there is no movement of the bowels Constipa- 
for the first three days, constipation being due to 
paralysis of the bowels caused by the pressure of 
the gravid womb upon the bowels. Regulation of 
the food will do much to correct this habit, as a 
laxative diet composed mainly of brown bread, oat- 
meal gruel, prunes, etc. An occasional enema of 
warm soapsuds may be needed, or from a tea- 
spoonful to a tablespoonful of glycerine may be 
injected into the lower bowel, or a glycerine or 
gluten suppository be given. If these means do 
not suffice, some medication may be needed. The 
laxative chosen by the physician will depend upon {^r 
the condition of the breasts, as well as its liability 
to affect the milk. 

Should the breasts be over-distended, a saline 
laxative will be preferred. Thus, two teaspoonfuls 



ce of 
laxative. 



l8o OBSTETRICAL NURSING. 

of Rochelle salts in a half-tumblerful of cold water 
may be given, an additional tumblerful of pure 
water being taken after it. Sulphate of magnesia 
or Epsom salts may be used in the same way, or a 
teaspoonful of cream of tartar may be taken night 
and morning in a cup of sweetened water. 

When the secretion of milk is scanty, a vegetable 
laxative is to be preferred, as rhubarb, aloes, or 
cascara sagrada. 
Enema of At times there is such impaction of the contents 

oil. L 

of the lower bowel that an oil injection will be 
needed. A gill of cotton-seed oil may be intro- 
duced into the lower bowel and retained for three 
or four hours, after which a small soap and water 
injection will lead to a thorough evacuation of the 
bowel. 
Care of The care of the nipples and breasts is very 

nipples and . xr i • i i 

breasts. important. It this matter has received proper atten- 
tion during the pregnancy, there will be compara- 
tively little trouble during the lying-in. It is 
important to keep the nipples clean. Milk should 
not be allowed to collect about them, hence imme- 
diately after nursing, while they are swollen and 
soft, they should be washed ; a soft piece of linen 
maybe used and cold water or a saturated solution 
of boracic acid, after which they may be dried with 
a soft cloth. This should be repeated after every 
nursing. 



MANAGEMENT OF THE LYING-IN. l8l 

If the skin of the nipple be unusually thin, it is Use of 
best to avoid having the baby pull directly upon shield. 
the nipple until the milk flows freely, hence a 
nipple shield should be used, at least for the first 
two or three days, if not longer. 

Should the nipple become sore at any time, the f^^ll^ 1011 
nipple shield should again be resorted to and used ni PP les - 
until the sore is healed. 

Some application, as a ten per cent, solution of 
tannic acid in tincture of myrrh, balsam of Peru, or 
a weak solution of nitrate of silver, according to 
the order of the physician, may be painted with a 
camel's-hair brush over the cracks in the nipple 
while it is soft and swollen, immediately after 
nursing.* 

For any nipple shield to work perfectly it mustQ ual £ iesof 
fit tightly, hence an entire rubber shield is not so shield - 
good as some others. Some shields are made of 
part metal and part rubber, others part rubber and 
part glass. The cheapest are the ordinary glass 
shields with rubber nipples. These cost about 
fifteen cents and are quite as good as those that are 
higher priced. 

A shield is not good if it allows the nipple to be 
drawn out too far. In the intervals of nursing the 

* It is better at night, when the applications cannot be kept con- 
stantly renewed, to anoint the nipples with a little borated cold 
cream after cleansing. This helps to prevent cracking. 



182 



OBSTETRICAL NURSING. 



Nipple 
protectors. 



rubber nipple should be kept in cold water after 
having been turned inside out and thoroughly 
cleaned with a brush. 

Nipple protectors are worn only in the intervals 
of nursing, or during pregnancy, for shaping the 
nipple.* These may be made of lead, glass, or 



Fig. 24. 




Nipple Shield. 

wood. Leaden protectors keep the nipples soft in 
the intervals of nursing, and have a healing effect 
upon the abrasions and cracks of a tender nipple. 
Unless care be taken, however, to cleanse the nipple 
thoroughly before the, baby nurses, there is danger 
of lead-poisoning. Nipple protectors of glass and 
wood, being open at the top, are intended more to 
keep the clothing of the patient off the tender 

* See Fig. 6, page 43. 



MANAGEMENT OF THE LYING-IN. 



183 



nipple.* The nipple may, in addition, be kept moist 
in the intervals of nursing by the application over 
it of a piece of absorbent cotton saturated with a 
mixture of one part glycerine to two parts water. 

Nipples vary much in shape — thus they may be Variation 



in shape of 
nipples. 



Fig. 25. 





Cone-shaped. 



Hollow. 




Mushroom-shaped. 



Depressed. 



cone-shaped, hollow, mushroom-shaped, and de- 
pressed. 

The cone-shaped nipple is the best, as it can becone- 
readily seized by the child's mouth, and the pres-ni PP ie. 
sure of the baby lips does not constrict the nipple 



* There is a form of nipple protector made of glass which also 
acts as a reservoir to catch the overflow of milk in cases where it 
flows involuntarily from the nipple. This is very nice in preventing 
the constant wetting of the patient's clothing. 



1 84 



OBSTETRICAL NURSING. 



at its base, so as to prevent the free escape of milk 

from the mouths of the milk ducts which open at 

Mushroom- the top of the nipple. The mushroom-shaped 

shaped a x x i 

nipple. 



Fig 




Figure-of-eight of One Breast. 



Hollow- 
nipple. 



nipple has so narrow a base that the free flow of 
milk may be thus prevented. 

The hollow nipple is apt to get sore from two 
causes: first, by the forcible suction made by the 
child in emptying the breast ; second, by the accu- 



MANAGEMENT OF THE LYING-IN. 



185 



mulation of milk in the depressed portion of the 
apex. 

The depressed nipple differs from the last class Depressed 

1 A nipple. 

in the fact that there is no elevation of the nipple 

Fig. 27. 




Figure-of-eight of Both Breasts. 



above the surface of the breast, but where the nipple 
should be there is a corresponding depression. 
Very little may be done for such a nipple, and all 



1 86 



OBSTETRICAL NURSING. 



Bandaging 
of breasts. 



efforts to make a nipple by drawing it out must 
generally be abandoned, as they simply irritate the 
tender skin. 

It is best when nipples of this class exist to 
abandon the idea of nursing the child, and prevent 
the accumulation of milk in the breasts by bandag- 
ing. This should also be done where there is a 
previous history of breast abscess — the breast 



Fig. 28. 





Garrigues' Breast Bandages. 



affected being thus bandaged to prevent the attempt 
at secretion by the gland. 

The firmest bandage is the figure-of-eight of the 
breasts, which maybe applied to one or both of the 
breasts according to need. If it cannot be used, 
the wide, straight bandage, similar to an abdominal 
bandage, may be employed, or the straight bandage 
with straps to fasten it over the shoulders, accord- 
ing to the pattern used by Dr. Garrigues, of New 



MANAGEMENT OF THE LYING-IN. 1 87 

York. Were the milk permitted to accumulate in 
the breast, and there be no ready outlet for it, 
" caked breast " would be apt to ensue. 

By " caked breast" is meant a collection of milk^'Caked 

J breast. 

in one or the other part of the breast, due to block- 
ing up of a milk-duct. The indications for its relief 
are to empty the breast. The milk may be drawn 
out by a baby if there be a proper nipple, or by the 
use of the breast-pump. 

The breast may be gently rubbed with warm oil^g t ingof 
and stroked from the base toward the nipple to aid 
in carrying the milk toward the mouths of the milk 
ducts. Camphor liniment is sometimes used as 
an inunction, alone or combined with laudanum, 
but unless it is the intention to help to dry up the 
milk, camphor should be avoided. 

The use of fomentations before rubbing greatly ^°™ enta " 
helps to soften up the breast. By fomentations is 
meant the application of flannels wrung out in hot 
water, constantly changed as they cool. These 
applications should be continued for fifteen to twenty 
minutes at a time. After their use if the baby be 
put to the breast or the breast-pump be used, "the 
milk will generally flow quite freely. 

Those breast-pumps are the best which depend Breast 

11 L pumps. 

for suction on the power of the mouth. The 

Phoenix breast-pump is the one generally preferred. 

They maybe used by the nurse, or a patient may 



i88 



OBSTETRICAL NURSING. 



use such a pump herself should a nurse not be 
present. Hand pumps are not good, as too much 
force is apt to be used in making suction — the nip- 
ple may thus be torn off. Where a breast-pump 
cannot be had, a simple contrivance may be resorted 
to for emptying the breasts which is often very 
effective. A bottle filled with very hot water may 
be emptied of its contents, and while still hot the 

Fig. 29. 




Breast Pump. 



mouth of the bottle closely applied over the nipple. 
As the bottle cools the nipple is drawn up into the 
neck of the bottle, and the flow of milk induced. 

When the breasts are pendulous, handkerchief 
bondage of bandages, properly applied, make a good support. 

Their application is as follows : " The base of the 
handkerchief, folded as a triangle, should be placed 
obliquely across the chest and under one breast, 



Handker- 
chief 



MANAGEMENT OF THE LYING-IN. 



189 



with the apex or summit of the triangle over the 
corresponding shoulder ; one angle is carried over 
the opposite shoulder, the other under the axilla, 
or armpit, of the same side. These ends should be 



Fig. 30. 




/ 1 

Handkerchief Bandage for Breast 



tied on the back of the shoulder, and the apex of 
the triangle pinned to them." — (Smith.) 

Should both breasts need support, a similar ban- 
dage may be applied to the other breast. To pre- 



190 



OBSTETRICAL NURSING. 



Modifica- 
tion of 
handker- 
chief 

bandage of 
breast. 



Straight 
bandage of 
breast. 



Double Y 
bandage. 



vent the base of one or both of these bandages from 
slipping up, the ordinary handkerchief bandage has 
been modified in the Woman's Hospital by the 
addition of a belt around the waist, of a strip of 
muslin or ordinary roller bandage, to which the base 
of the bandage may be fastened by safety-pins. 

A simple straight bandage, with a compress to 
lift the outer, pendulous portion of each breast, is 
sometimes used. 

Another bandage, which has the advantage of 
not requiring to be removed when the baby nurses, 
is the double-Y bandage, used in the Boston Lying- 
in Hospital. The manner of putting it on is thus 
described by Dr. Worcester : " A single T bandage 
is first made by folding a napkin lengthwise so that 
for an average-sized patient it shall be 32 in. long 
by 3 in. wide. At the middle of this, and at. right 
angles to it, is pinned, just between its folds, a nap- 
kin of the same size, similarly folded. This T ban- 
dage is next made into a Y bandage, by making a 
diagonal fold in the middle of the cross-piece and 
fastening the corners of the plait with safety-pins 
on the outside. The bandage is now ready to put 
on. The tail-piece is passed under the woman's 
back, snug up to her armpits, so that the fork of the 
Y just clears one nipple when that breast is held 
upward and inward on the chest. The tail-piece 
on the other side is carried up on the chest directly 



MANAGEMENT OF THE LYING-IN. 



I 9 I 



over the breast. The arms of the Y are then 
brought over the chest, one above and the other 



Fig. 31. 




Worcester's Y Bandage. The upper figure shows the double Y breast bandage 
in position ; the lower left-hand figure shows how the Y bandage is made. 
The third figure shows how the double Y bandage is completed by fasten- 
ing the arms of the Y to the tail-piece on the patient's opposite side. 



below the breasts, and their ends pinned to the tail- 
piece, so as to hold both breasts in similar posi- 
tion. A compress of soft linen may be placed 



192 OBSTETRICAL NURSING. 

between the bandage and the outside of the breasts 
and also between the breasts, to prevent their chaf- 
ing. To keep the bandage from slipping down 
straps of muslin may be passed over the shoulders 
and pinned back and front. To keep it from slip- 
ping up, it may be fastened to the abdominal 
bandage." The bandages referred to are very use- 
ful while the patient is in bed, but when she begins 
to sit up and wear ordinary clothing they will be 

Fig. 32. 




Obstetrical Breast Support, with Knitted Bosoms. 

found to be cumbersome. Some such breast sup- 
port as is shown in Fig. 32 may then be found very 
useful. It may be obtained at the Dress Reform 
Emporium, in Philadelphia, and at similar agencies 
in other cities. 
Gathered There is nothing in the care of a lying-in patient 

breasfs. > ° . 

for which a nurse receives more blame than in the 
occurrence of gathered breasts. Abscesses will 
sometimes come, however, in spite of all precau- 
tions, even before confinement. Extreme watchful- 



MANAGEMENT OF THE LYING-IN. 1 93 

ness and a prompt reporting of any symptoms of 
beginning trouble, as chilliness, hardness of the 
breasts, sore nipples, etc., will do much to avert 
them. It must never be forgotten that sore nipples, Septic 

& rr ' inflamm 

by offering an open surface upon the mother's body, £° e n a °f 
may become avenues of septic infection. Dirty 
hands or dirty garments touching these surfaces or 
poison from the baby's mouth may thus enter the 
mother's system. One of the most serious forms 
of inflammation of the breast may thus result from 
blood-poisoning. If the breast has once gathered, 
there will be a tendency for it to gather again. 
Should an abscess threaten by beginning inflamma- 
tion of the breast, the treatment will, of course, be 
directed by the physician. What milk is in the 
breast must be drawn out, and some means used to 
prevent further secretion. Belladonna breast plas- 
ters were atone time much used, the circular breast 
plasters being obtained at any drug store. The 
belladonna ointment spread on patent lint, shaped 
to the breast, is preferred by some physicians. 
Simple compression of the breast by a firm bandage 
is generally sufficient, without the aid of other 
measures, in the checking of the secretion 

Should the breast gather, lancing is inevitable, 

and the sooner the better, so that a nurse should 

keep the physician carefully informed as to the 

condition of the breast. Flaxseed poultices may 

13 



194 OBSTETRICAL NURSING. 

need to be applied for a time, both before and after 
lancing. These poultices, to do any good, should 
be applied as hot as possible. The nurse can test 
the heat of the poultice by laying her cheek against 
it. If she can bear this application without finding 
it too hot, the patient will also probably be able to 
bear it. If the poultice be made on flannel it will 
not lose its heat as quickly as when made on muslin. 
The poultices will require changing about once in 
two hours, or often enough to keep them warm ; 
and should be kept up until the abscesses point and 
are evacuated. The nurse should encourage the 
patient to have an abscess lanced, and should have 
prepared, at the time of the operation, the antiseptic 
solutions preferred for the physician's hands and 
for washing out the abscess cavity, a syringe, if 
possible, a pus-pan having a concave side to fit 
closely under the breast, some charpie (linen 
threads arranged in bundles, for packing abscess 
cavities), soft towels, and some absorbent cotton to 
be used in place of sponges for cleansing the breast. 
Before the operation, the breast should be washed 
off with an antiseptic solution. Between the appli- 
cations of the different poultices the breast should 
be similarly washed off by the nurse. The 
physician will probably desire to wash out the 
abscess cavity daily so long as the discharge of pus 
continues, in which case the nurse should have 



MANAGEMENT OF THE LYING-IN. 1 95 

everything in readiness at the time of his expected 
visit. 

Sometimes milk runs constantly from the breasts. Constant 

J now of milk, 

Much may be done to prevent this by regular 
nursing. If it persists, the amount of liquid in 
the food should be restriced. Sometimes the milk 
runs from the opposite breast while the baby is 
nursing at one. There is no way to prevent this. 
Some mothers collect it as it drops in a small bottle 
or cup and feed it to the baby. 

If the mother has only sufficient milk for half insufficient 
the day, the baby had better be artificially fed by 
day, the breast milk being reserved for the night, 
as giving less trouble when the care of the child 
devolves upon her. 

After-pains are the same as labor-pains, being After-pains, 
caused by contractions of the womb. They are 
called after-pains because they occur after confine- 
ment. A woman, after the birth of her first baby, 
seldom has after-pains. They may occur with vary- 
ing severity in women who have previously borne 
children. If the bladder and the bowels are properly 
attended to, and the womb kept well contracted, the 
patient is not likely to suffer much from after-pains. 

These pains seldom last over the second day. 
Should they do so, it is probable that the patient is 
threatened with some inflammation. 



I96 OBSTETRICAL NURSING. 

The occurrence of after-pains should, of course, 
be at once reported to the doctor, and such meas- 
ures for relief carried out as he may suggest. 

The womb will be found to be in two entirely 
different conditions with the occurrence of these 
pains. Hence, we divide the pains into two classes, 
the " expulsive" and the " spasmodic," or " neu- 
ralgic." 
si^ X " ul " With expulsive after-pains the womb, as it is felt 

S?S!T through the abdominal walls, will be found to be 

large and soft, and the patient will often pass clots. 
The bladder will be frequently found to be over-full 
and the womb pushed high up or to one side. The 
indications are to empty the bladder and to secure 
good contractions of the womb. After the bladder 
is emptied the pain may be relieved by the applica- 
tion of a hot poultice over the lower part of the 
abdomen, and simple fluid extract of ergot may be 
given, if desired by the physician (j4 teaspoonful 
every three hours), until the womb is well contracted. 
A nurse should never give any medicine without 
the direction of the physician. Before entire relief 
is obtained it may be necessary for the physician to 
injecttons!" 6 break down and wash out the clots within the womb. 
The nurse should slip drawers and stockings on 
the patient in preparation for this operation, as she 
may need to lie across the bed with her hips drawn 



MANAGEMENT OF THE LYING-IN. 1 97 

to its edge. A bed-pan, syringe, antiseptic solu- 
tions, receptacle for waste water, and rubber pro- 
tective for bed and floor should be prepared. 

When spasmodic after-pains occur, the womb is Spasmodic 

1 after-pains. 

felt in the lower part of the abdomen as a firm, 
round ball of stony hardness. This is caused by a 
spasm of the muscle fibres in the womb. The 
remedies which would help expulsive pains would 
only aggravate this condition. Something must be 
employed which will quickly relax the spasm. The 
most efficient agent is_ chloroform liniment, which 
may be applied on flannel over the lower part of 
the abdomen. The active counter-irritation thus 
produced will give relief. Should the spasm be 
very severe, the physician may apply pure chloro- 
form sprinkled on blotting-paper, for a few seconds, 
over the lower part of the abdomen until it well 
reddens the skin. Should no chloroform liniment 
be at hand, a warm flaxseed poultice may help to 
some extent, though not so efficient, as a rule. 

A careful report should be kept by the nurse, The report. 
from which the physician can learn all that has 
transpired in the intervals of his visits. 

Sheets of paper ruled and having headings, as in 
the following plan, are used in the Woman's Hos- 
pital. 



198 



OBSTETRICAL NURSING. 



I 5 



S 



° S 






OS 

S 
w 

OS 




•JLNHWHAOIM 

iHM-oa 




'HNIHa 




H 

z 

w 

< 

« 

H 
Q 

< 
u 

s 

w 

a 


• 


Q 







•JSHH 


• 


•JIM3X 




•asina 




•haoh 




■3iva 








S 



MANAGEMENT OF THE LYING-IN. 1 99 

The occurrence of pain, any complaint of chilli- Special 
ness or a decided chill, rise of temperature, rapid to be 

r reported. 

pulse, sleeplessness, headache, want of appetite, etc., 
should be carefully noted and brought to the physi- 
cian's attention. 

For the first week or ten days it is well to take 
the temperature and pulse in the morning, at noon, 
and in the evening ; after which, if the patient is 
doing well, the morning and evening temperature 
and pulse will be sufficient. 

Should the slightest complaint of chilliness beChiii. 
made, the nurse should place extra covers around 
the patient, hot-water bottles, if necessary, to warm 
her up, and at the same time give her a warm drink, 
as a cup of hot tea or even hot water. 

The temperature should always be taken after a Rise f 
complaint of chilliness, and taken quite frequently, tur^ 6 ™" 
as every hour or two, when, if it be found to be 
rising, a note should at once be sent to the 
physician, who may want, under the circumstances, 
to see the patient at once or institute some new line 
of treatment. Pain may be temporarily relieved by Pains. 
the application of a hot flaxseed poultice. Grave in- 
flammatory and septic troubles are ushered in by 
such symptoms as the above, hence no time should 
be lost in notifying the physician of their oc- 
currence. 

The use of blisters, poultices, packs, vaginal in- ^ve!? 6 ™ 1 



200 OBSTETRICAL NURSING. 

jections, and medicinal remedies required in the 
treatment of the various forms of " puerperal fever " 
must, of course, be in exact accordance with the 
physician's directions. 

Such troubles are generally septic, that is, arise 
from blood-poisoning; and one very important 
duty of the nurse will be to see that the patient 
takes sufficient nourishment to combat the poison 
in the blood. 

Stimulants should never be given without a 
physician's advice, but when ordered great care 
should be exercised in their faithful administration. 
Egg-nog, milk-punch, whisky-punch, wine-whey, 
milk in the various liquid and semi-liquid prepara- 
tions, beef-tea, broths, etc., will be called for. The 
nurse should be ready with devices to tempt her 
patient to eat, and thus give the most important aid 
to the arrest of the disease. The support of the 
strength, with extreme cleanliness and thorough 
antisepsis, will do much to arrest the course of the 
terrible maladies due to blood-poisoning. 
Puerperal The existence of any sores about the vulva or 
vagina, when discovered by the nurse, should at 
once be reported to the doctor. These are espe- 
cially dangerous when they take on a grayish sur- 
face, as this indicates that they have already become 
infected by poison. If the disease is not arrested 
here, the whole system may be involved. 



ulcers. 



MANAGEMENT OF THE LYING-IN. 201 

A swelling of one or both legs sometimes comes Milk leg. 
on after delivery. It is ushered in by acute pain 
and lines of redness accompanying the swelling — 
the vessels of the groin, under the knee, or in the 
leg will often feel like cords. This is due to an in- 
flammation involving the veins. Sometimes blood 
clots form in the veins, which may be dislodged and 
carried to the heart and lungs, when they are the 
source of the gravest danger. Sometimes abscesses 
form in the leg. The great danger of clots being 
carried in the blood current makes absolute quiet 
imperative. The patient should lie flat on her back, 
and the limb be elevated on pillows or on an in- 
clined plane, such as the fracture-box used in certain 
fractures of the lower extremity. 

The application of some soothing ointment, as 
iodine and belladonna ointment in equal parts, over 
the cord-like veins, a hot flaxseed poultice being 
kept over the ointment, will help to relieve pain and 
diminish inflammation. The whole limb should be 
kept warm by a wrapping of cotton batting. The 
limb is most comfortable when slightly bent at the 
knee joint. Should the weight of the bed-clothing 
cause pain a cradle may be made of barrel hoops 
for lifting them off the limb. The cradle is also 
very useful in cases of peritonitis when the same 
difficulty exists. 

Lying-in women should not be subject to bed- Bed _ sore! 



202 OBSTETRICAL NURSING. 

sores, but should some complication occur, as in 
some form of blood-poisoning, or should some 
other disease attack the patient during this time, 
necessitating long lying, special care is necessary 
to prevent bedsores. The parts of the body sub- 
jected to most pressure should be kept thoroughly 
dry and rubbed with alcohol and alum (a 
saturated solution) once or twice daily. A little 
cosmoline may then be rubbed into the skin, or 
some drying powder, as zinc or starch, may be used. 
When a sore occurs it must be dressed, according 
to the physician's order, with zinc ointment or 
cosmoline. All pressure should be kept off it, if 
possible, by the adjustment of pads and pillows or 
a rubber-ring cushion. 

man r ia eral Puerperal mania is a form of mental trouble 
which may affect lying-in patients, particularly 
when they are exhausted from any cause, whether 
it be mental worry or physical ill-health. In true 
mania the patient may be violent and very difficult 
to control. In the melancholic type of this trouble 
she is exceedingly depressed, distrusts her best 
friends, and cannot be roused to take an interest in 
her surroundings. 

Removal As soon as it is noticed that the patient's mind is 

of infant. A 

not well balanced the baby should be removed 
from the room, only being brought to the mother 
when asked for. The nurse should then keep a 



MANAGEMENT OF THE LYING-IN. 203 

close watch over it, as one of the chief symptoms of 
this trouble is a strong aversion to the baby 
and desire to destroy it. 

It should never be forgotten that an insane pa- importance 

x ofwatcn- 

tient should not be left alone for a moment. The fulness - 
insane are very cunning, and though apparently 
asleep, may be but watching their opportunity to 
indulge in some mad freak, as jumping out of the 
window, dashing down the stairway and out of the 
doors, etc. The windows, therefore, should be in 
some way protected. A nail or screw may be 
driven into the window-casing so as to prevent the 
raising of the sash, except so far as ventilation re- 
quires. The door had best be kept locked, the 
nurse keeping the key. 

The treatment will mainly consist in keeping up Treatment. 
the nourishment and in kind, gentle, tactful man- 
agement. The patient should be made to interest 
herself in outside things, by the judicious turn 
given to the conversation by the nurse, by engage- 
ment in some kind of fancy-work, or in games 
which will help to divert the mind. 

She should not be crossed, neither should she be 
deceived. The nurse should so manage her as to 
inspire a thorough confidence and liking toward her 
on the part of the patient. If she has not these, 
she had best give' up the case, as she will not be 
able to help the patient. 



204 OBSTETRICAL NURSING. 

Forced, or Should the patient absolutely refuse to eat, the 

artificial ... -. . . 

feeding. physician may direct the nurse to introduce the 
food into the stomach by means of a rubber tube 
passed through the nostril and down the oesopha- 
gus, or gullet. Care should be taken to do no 
injury in the introduction of this tube, which should 
be well greased with cosmoline and made to follow 
closely the direction of the passages it is made to 
enter. A funnel is then connected with the outer 
extremity, through which the milk or broth, etc., 
may be poured into the stomach. 

Securing of Should the patient be exceedingly restless and 

patient. disposed to jump out of bed, to her own detriment, 
she may be fastened into the bed by means of a 
sheet, doubled lengthwise, placed over the middle 
portion of the body from the arm-pits to below the 
knees and carried under the bed, to be fastened 
either beneath the bed or to one side of it. The 
feet may be bound together loosely at the ankles 
by a piece of roller bandage and fastened to the 
footboard of the bed. The hands may be bandaged 
together (being placed the one on top of the other) 
by means of a roller bandage, though this is not 
necessary except when they are used to do herself 

Trans- iniury. Where patients are so violent as to need 

ference to J J x 

an institu- suc h restriction, however, it is better to have them 

tion for the ' 7 

insane. removed to some institution for the insane as soon 
as possible, where there is better provision made 



MANAGEMENT OF THE LYING-IN. 205 

for their management. The use of sedative reme- 
dies by the physician will generally prevent the 
necessity for resorting to such extreme measures 
for confining the patient in ordinary cases. 

Medicines should, of course, never be left in the -P rotection 

7 from 

patient's room, even when the nurse is there, unless poisoning. 
under lock and key. The duration of this malady 
varies from weeks to months, in some cases be- 
coming chronic. Convalescence is generally very 
gradual. Patients may have long periods of lucid 
thought, and seem apparently well, only to unex- 
pectedly return to their vagaries ; so that the nurse 
should never relax her quiet vigilance while in 
charge of the case. 

The old time-honored belief that a woman should The first 

sitting-up 

sit up on the ninth day is subject to many excep-^^ er 
tions, which should be understood by the nurse as 
well as by the physician. The true gauge is the 
progress of involution. This may be determined 
by the height of the uterus (which ought to sink 
behind the pubic bone before the patient is allowed 
to sit up) and by the character of the discharges. 
So long as there is any blood in the discharges the 
patient should not sit up, for this is an indication 
that involution, or the shrinking of the womb, is 
not going on properly. This condition is known 
as " sub-involution," and if neglected may lead top^jj v °- 
chronic disease of the womb. The use of the re- 



2o6 OBSTETRICAL NURSING. 

cumbent or semi-recumbent posture, frequent hot 
injections given by the nurse, or electricity admin- 
istered by the physician, may be necessary to over- 
come it. Let the patient understand the wisdom 
of her confinement to bed under such circum- 
stances, and she will generally yield gracefully to 
the necessity. The first sitting-up should be in 
bed, the patient's back being supported by a bed- 
rest. Should no bed-rest be found in the house, 
a chair turned upside down, with its back toward 
the patient, over which a pillow is placed, offers a 
very good substitute. 

After sitting up in bed for a day or two, from a 
half-hour to an hour if there be no discharge, the 
patient may have her flannel wrapper and stockings 
and bedroom slippers put on, and be allowed to sit 
up in an easy chair. It must be remembered that 
this is the time when the patient will be most 
susceptible to cold, therefore every precaution must 
be taken to prevent her exposure to draughts. 
Should the patient seem to grow tired before the 
half-hour or hour is up, she should be put back in 
bed. The interval for sitting up may be gradually 
increased from day to day, until she is up the 
greater part of the day. No going up and down 
stairs should be permitted until the physician sanc- 
tions it, which is, in ordinary cases, about the fifth, 



MANAGEMENT OF THE LYING-IN. 



207 



or sixth week, when one such journey a day is 
generally permitted. 

That there may be no misunderstanding between observance 

J ° ofphysi- 

physician and nurse, the orders of the physician cjan'^ 
in every case should be immediately set down in 
writing when given, so that by constant reference 
to them the nurse may do her full duty by the 
patient. It is well, for this purpose, to have a piece 
of paper ruled so that at the right side there shall 
be two columns, one headed A.M., the other P.M. 
The stated hours for the administration of medicine 
or carrying out of treatment may then be placed 
opposite the special directions for each, and a pencil 
mark be drawn through the figure representing the 
hour when the matter has been attended to. 

An order board, as used in the Woman's Hos-°^ r e d r # 
pital, is prepared as follows : — 

Orders for Treatment of Mrs. Richards, Oct. 10, 1889. 



Full breakfast, dinner, and supper, . . „ 
A teaspoonful of medicine (light or dark), 

Sponge bath, 

Lunch of gruel or beef-tea, 

Glass of milk at bedtime, 

To sit up half an hour with bed-rest, . . 



A.M. 



6 

6.30 

10 

9 



P.M. 



12, 6 

I2.3O, 6.3O 

3 

8 



Nurse's Name- 



208 OBSTETRICAL NURSING. 

A fresh board should be prepared for each day's 
work. In ordinary cases, which run an uneventful 
course, these boards, with the hours crossed off, 
serve the purpose of a report as well. 



CHAPTER XIII. 

CHARACTERISTICS OF INFANCY IN HEALTH 
AND DISEASE. 

A healthy baby, if born at full term, should w l\ghft{ 
weight 3250 grammes, or about seven pounds. ItSbaTy. 01 
length should be, on an average, 50 cm., or twenty Average 
inches. 

The head and trunk of the child are developed ^is of de- 
out of proportion to the limbs, so that the navel is velopment - 
below the middle of the child's body. This greater 
development of the upper part of the body is due 
to the fact that in the womb this portion of the 
child's body receives the greater amount of nour- 
ishment. The subsequent growth consists largely 
in the development of the lower limbs. 

The skin of a new-born baby varies in color from skin. 
a pink to a decided red. The redness is more 
marked in premature babies. From the third to 
the fourth day this redness disappears, and the 
peculiar yellowish tinge, known as " baby jaun-!^^ e „ 
dice," appears, as a result of the changes in the 
circulation. This is not true jaundice. This yel- 
lowish tinge of the skin should disappear by the 
H • 209 



2IO 



OBSTETRICAL NURSING. 



The form. 



Shape of 
head. 



Effect of 
pressure. 



Sutures. 



end of the second week. At the same time that 
the skin begins to change color, from the third to 
the fourth day, it begins to scale or peel off. This 
is most noticeable about the fifth day, and lasts 
about sixteen days. 

The baby's limbs should be plump and well- 
rounded. The abdomen is prominent, as compared 
with the chest. 

The shape of the head varies very much. At 
times it is perfectly rounded, again it will be elon- 
gated and oval-shaped. 

Pressure during labor, either from the walls of 
the pelvis or as a result of the use of instruments, 
will cause at times considerable temporary distor- 
tion in the shape of the head. To allay swelling 
and prevent discoloration induced by bruising, 
fomentations may be used, either of simple hot 
water or hot water containing a little fluid extract 
of hamamelis. 

When there has been a good deal of pressure on 
the baby's head during the birth, the bones will 
sometimes override each other, and this will be 
shown by elevations or ridges upon the baby's 
head, which soon disappear when the head is no 
longer subjected to pressure. These ridges, which 
are converted into soft grooves on the removal of 
pressure, indicate the separation between the dif- 
ferent bones of the head, and are called " sutures." 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 211 

The larger soft places are called " fontanelles." The Fontanels, 
largest is on top of the head just above the fore- 
head. It is called the " anterior fontanelle," com- 
monly known as "the opening of the head." It is 
about large enough for the tips of two fingers to 
cover, when of normal size, and is kite-shaped. A 
much smaller three-cornered fontanelle is found at 
the back of the head and two behind the ears. 
These very soon fill up with bone. 

The large anterior opening does not close entirely closure of 
until a child is about eighteen months of age. fonuneUe. 
Should it remain open longer, it is a sign of con- 
stitutional weakness. In a healthy baby the sur- 
face of this fontanelle should be on a level with the 
surrounding bones of the skull. A slight pulsation Pulsation of 

& & JT fontanelle. 

may be noticed in it, due to the pulsation of the 
blood vessels in the brain. Should the fontanelle 
be much depressed at any time, it would indicate a ^ epression 
low state of vitality. Care should be taken not tb fontanelle - 
permit any undue pressure on this part of the baby's Avoidance 
head, as the brain here lies very near the surface. ° pre 

The fashion some old monthly nurses have of 
trying to shape the head by the pressure of the 
hands is dangerous, as the brain may be thus 
injured. As the head bones are soft, the child 
should not be allowed to lie too continuously on 
either side or on the back, as this will cause flatten- 
ing of the part pressed upon. 



212 



OBSTETRICAL NURSING. 



Changes in 
weight. 



Average 
daily gain, 

Loss and 

gain. 



For the first two days of a baby's life it loses 
weight, but by the third day it begins to gain, and 
by the end of the first week it should weigh what 
it did at birth. The average daily gain is 30 
grammes, about 1 oz. The following facts con- 
cerning the early changes in weight are obtained 
from Gregory : — 

An infant born at full term weighs from 6 to 7 
pounds, 7 pounds being an average weight. For 
the first two or three days of life there is a loss of 
4 ounces to 7 ounces, then a regular gain, so that 
by the eighth to the ninth day the initial loss has 
been made good. The following figures express 
the average daily loss and gain during the first six 
days of life : — 



First day, . 
Second day, 
Third day, 
Fourth day, 
Fifth day, 
Sixth day, 



Loss of 139 grammes, or nearly 5 ounces. 

" 64 " " 2j^ounces. 

Gain of 33 " about I ounce. 

" 50 " " i^founces. 

" 50 " " I jounces. 

" 36 " " 1 jounces. 



The child's weight should be doubled in the fifth 
month, and trebled in the twelfth month. The 
baby should be able to hold up its head in the 
sixteenth week, at the same time sitting up. It 
should stand by the thirty-eighth week. It should 
" take notice" and be able to grasp things by the 
third to the fourth month. 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 2 1 3 

It is important that a nurse should know the 
above facts as to the child's development, to be 
able to report satisfactorily concerning its condition 
to the physician in attendance. 

A large proportion of the time of early infancy Sleep> 
is spent in sleep. The more premature the baby, 
the more constantly does it sleep. During sleep 
the eyelids should be tightly closed. A partial 
separation of the lids, showing the whites of the 
eyes, is an indication either of some disease, or of 
pain, from whatever cause. 

The respirations of a healthy baby when awake Respira- 

, ..... tions. 

may be very irregular, some inspirations being 
shallow and others deep — at times hurried, and 
again slow. The only time when the respirations 
can be satisfactorily counted is when the child is 
asleep, for then the breathing is more regular. The 
rise and fall of the abdomen may then be noted 
(for the breathing of an infant is abdominal). The 
number of respirations in a minute average 44. So 
quiet is the healthy breathing of early infancy that 
there is no motion of the nostrils or of the lips, or 
even of the chest, to indicate the incoming and out- 
going; of air. Fever, colic, and lung trouble will 

b fe ' ' & Increase in 

greatly increase the number of respirations in a respirations. 
minute, making them mount up to 60 or 80, or 
even higher. Nervous excitement has a similar 
effect, though this is temporary. 



214 



OBSTETRICAL NURSING. 



Slowing of 
respirations. 



Painful 

breathing. 



; Cyanosis. 



Infantile 
pulse. 



Tempera- 
ture 



Sub-normal 
tempera- 
ture. 



In brain trouble, a slowing of the respirations 
occurs, so that they may get down to 8 in a minute. 
When the act of breathing is painful a moan or cry 
accompanies each act of respiration. The expan- 
sion of the nostrils with each inspiration indicates 
a want of sufficient air space in the lungs. In con- 
nection with any lung trouble a bluish coloration 
of the lips and face generally is a bad symptom, as 
it indicates that sufficient air does not enter the 
lungs to purify the blood. 

Little reliance is to be placed upon the pulse of 
a baby as indicative of disease, for it is characteris- 
tic of the infantile pulse that it is very rapid, very 
easily affected by external or internal causes, and 
notably irregular. The average pulse of the new- 
born baby is 140. If a baby is well-nourished, it 
is too fat to enable the pulse in the radial artery 
to be counted. Hence the pulse is more easily 
obtained in the temple or at the ankle. If not 
thus readily obtained, the heart beats may be 
counted by holding the hand over the baby's heart. 
The temperature of a child of this age is also 
subject to rapid changes, the result of slight causes. 
The average temperature is 99 ° Fahr., but a cold 
or an attack of indigestion may cause a sudden 
increase, with as sudden a return to normal when 
the cause is removed. 

A sub-normal temperature is an indication of 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 21 5 

lowered vitality, the result of some drain upon 
the system, as of an exhaustive diarrhoea, or of 
some constitutional weakness. This fall of tem- 
perature is a dangerous symptom in infants. The 
tip of the nose and the extremities of the child, if Symptoms 

1 of lowered 

cold, also indicate a condition of low vitality, and vitality. 
require that the child should receive very especial 
care from the nurse as to the supply of food and 
warmth. In fever the back of a child's head feels 
very hot, as also do the palms of the hands. The 
cries of a child form a special language by which The 
its needs may be made known. Every nurse a a c?y. age( 
should learn to distinguish the peculiarity in the 
different kinds of cries, so as to meet the varying 
demands thus indicated. A healthy, well-trained 
baby rarely cries, unless hungry, when the cry will of hunger. 
be constant and very persistent until the want is 
satisfied ; the upper part of the body is moved at 
the same time, especially the arms and head. The 
cry induced by ear-ache is also unappeasable, and Ear-ache. 
generally accompanied by a drawing of the hand 
up to the head. A similar gesture accompanies 
the cry induced by brain trouble, which is a shrill Brain 

trouble. 

scream, often waking the child during sleep. 

A cry accompanying a cough is an indication of ^| le 
pain in the chest. The paroxysmal character of 
colic is indicated by the characteristic cry which colic. 
accompanies it — a sharp, sudden cry — the limbs at 



2l6 OBSTETRICAL NURSING. 

the same time being drawn up toward the abdomen. 
An evacuation of the bowels may precede or follow 
the cry. 

Sore mouth. If, in nursing, a baby seizes the nipple by the 
mouth and drops it suddenly with a cry, doing this 
repeatedly, there is in all probability some soreness 
of the mouth, which should be discovered and 

Secretion of treated. However heartrending the cry, the baby 

tears. does not secrete tears until the third month of in- 

fancy. Hence the common saying, that a baby 
cannot suffer pain because it sheds no tears while 
crying, is not supported by fact. 

Facial A wrinkling of the forehead vertically, produced 

expression. ,,.-'•■ ■, i • i • 

by drawing the eyebrows together, indicates pam 
about the head. A sharpening or play of the nos- 
trils exists in lung troubles. A drawn look about 
the mouth is found with digestive troubles, as flatu- 

movelnents ^ en ^ c °li c - The stools of a very young baby fed 
on breast milk should be of a yellow or orange 
color. Three or four evacuations a day are natural. 
They should contain no curds. Stools of bottle- 
fed babies are lighter and more offensive. The 

Urination, number of times a new-born baby urinates will 
vary much with the weather and the conditions 
under which the child is placed. It is not unusual 
in cold weather for the napkin to need changing 
almost every hour. Healthy urine should not 
stain the napkin. 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 2\J 

Mothers and nurses are often much troubled by Retention 
the failure of an infant to pass urine or faeces for and faeces. 
the first few hours or days of its life. A careful 
examination of the anus or external opening of the 
bowel will soon show whether there is any imper- imperforate 

J l anus or 

forate condition of the rectum, which may cause urethra - 
the retention of faeces. Closure of the urethra is 
so rare that retention of urine is very seldom seen. 

The new-born infant secretes but very little urine 
until it begins to take nourishment freely. The 
bladder is usually emptied during the process of 
birth, as also is very frequently the case with the 
bowels, so that if the child seems well and there 
is no malformation of the parts, the family may be 
assured that the condition is only temporary. 

The use of fomentations over the kidneys and 
bladder will frequently hasten the evacuation of 
urine if it be unduly delayed. If the secretion 
seems highly concentrated, as is shown by the 
brickdust deposit sometimes found on the baby's 
diaper, a drop of sweet spirits of nitre in a tea- 
spoonful of water may be given once in two hours. 

Should the child seem to suffer pain from the 
retention of the contents of the bowel, an ounce of 
warm water or olive oil injected into the rectum 
will usually produce a satisfactory evacuation. 
Should a laxative by the mouth be needed, the 
physician must be consulted. A teaspoonful of 



218 



OBSTETRICAL NURSING. 



Dentition. 



Early 
dentition. 



Symptoms 
accompany- 
ing 
dentition. 



Eruption 
of teeth. 



sweet oil often serves the purpose very nicely, or 
a few grains of manna dissolved in milk. 

The teeth sometimes appear prematurely. A 
child may be born with one or more teeth already 
cut. These are usually imperfect, and fall out in a 
short time, to be replaced by the milk-teeth. The 
latter are twenty in number and are usually cut in 
groups, starting about the fourth month and con- 
tinuing till between the twentieth and thirtieth 
months, when the first dentition should be com- 
plete. Girls are more apt to cut their teeth early 
than boys ; and, as an early dentition is usually an 
easy one, it is fortunate for the child to have it 
occur early. 

Even under normal conditions the edges of the 
gums in teething become swollen, rounded, and 
reddened as the teeth come near the surface. The 
saliva is at the same time increased in quantity, and 
the mouth is heated and uncomfortable, so that the 
child desires constantly to bite upon any object 
that may be at hand. A healthy child should not 
suffer in any way from the process of dentition, and 
when the point of the tooth comes through the 
gum the local symptoms may vanish. These are 
cut in groups, there being an interval of rest be- 
tween the eruption of each group. 

The following diagram will illustrate the order 
in which the teeth are cut. The numbers I to 5 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 219 

show to how many groups the several teeth belong 
and the order in which the groups appear. The 
letters a and b show the order in which the teeth 
in each group appear. 

Bottle-fed babies are more apt to be late cutting J ate . . 

1 <=> dentition. 









Fig. 33- 


or 


4 


2 


a & 

2 2 


3_ 










3 113 
b & 

Diagram Showing Eruption of Milk Teeth.* 

1. Between the fourth and seventh months. Pause of three to nine weeks. 
2, 2, 2, 2. Between the eighth and tenth months. Pause of six to twelve 
weeks. 3, 3, 3, 3, 3, 3. Between the twelfth and fifteenth months. Pause 
until the eighteenth month. 4, 4, 4, 4. Between the eighteenth and twenty- 
fourth months. Pause of two to three months. 5, 5, 5, 5. Between the 
twentieth and thirtieth months. 



their teeth than those that are breast-fed. If no 
teeth have appeared when the child is a year old, 
we may know that the child's general nutrition 

* From Starr, " Diseases of the Digestive Organs in Infancy 
and Childhood." 



220 OBSTETRICAL NURSING. 

is at fault, or it may have the disease known as 

rickets. 
demftilTn Bottle-fed babies are also apt to have their teeth 

come through the gum in irregular order. This 

frequently is an indication of lack of health, 

although sometimes it is a family peculiarity. 
Milk teeth. The first set of teeth which the child has is 

called the temporary set. It consists of twenty 

teeth, known as milk teeth. 



CHAPTER XIV. 
THE AILMENTS OF EARLY INFANCY. 
It is not proposed in this chapter to take up all Definition 

• r • of infancy. 

the ailments of infancy, for the term "infancy " 
comprises a time beginning with the birth of the 
child and lasting until the first dentition. 

The obstetric nurse remains with the patient from 
four to six or eight weeks. During this time many 
deviations from the normal, healthy state may be 
met with in the child, and these she should be 
quick to observe and know how to manage. 

One of the most important conditions of this p r 
period is "prematurity," a result of the too early 
birth of the child. 

A premature birth is one that occurs at any time 
after the child is "viable," that is, capable of living 
after its birth. The term of viability has been set viability. 
at twenty-eight weeks, or seven lunar months. 
Deliveries occurring previous to this time are 
called " miscarriages." 

It may be that with improved methods of man- 
agement, the period of viability may be placed at 

221 



rema- 
turity. 



222 OBSTETRICAL NURSING. 

an earlier date, but this is as yet a matter for 
proof.* 

It has generally been conceded that a child born 
at six lunar months cannot live, that at seven 
months it stands little chance, that at eight months 
its chances are better, and at nine still better. 

The popular notion that an eight-month baby 
(counting the calendar months) does not stand as 
good a chance of living as a seven-month baby is 
altogether wrong. Great care is needed for prema- 
ture babies. They especially need regular feeding 
and to be kept very warm. The skin, being thin and 
delicate, will also require very careful attention. 

Until within a few years the matter of keeping 
the baby sufficiently warm was exceedingly difficult 
The to manage. The French invention of the " cou- 

"couveuse." veuse) " or " brooder," has simplified the matter 
very much. It was first used in some of the French 
lying-in hospitals in 1 88 1. Since then it has come 
into quite general use in France, being employed 
even in private houses. Many different forms of 
the apparatus now exist. Theone most commonly 
used in France is Tarnier's invention. This has 
been used for some time with great satisfaction in 
the Woman's Hospital, of Philadelphia. 

* The French claim that by means of gavage and the couveuse, 
or hatching-cradle, the actual period of viability has approached six 
months of intra-uterine life. 



THE AILMENTS OF EARLY INFANCY. 



223 



It consists of a wooden box, whose interior is 
divided into an upper and lower compartment. 
There is a space about four inches wide at one end 
of the upper compartment which communicates 
with the floor below. Here two or three large 
sponges on a wire stem are placed. The lid of the 
box at the. opposite end contains a chimney, in 
which a helix rests on a pivot. 



Fig. 



34- 




Tarnier's Couveuse. 



The upper compartment of the box is intended 
for the baby ; in the lower end are several stone jars, 
which are to be kept filled with very hot water. At 
the end of the box furthest away from the open 
space which communicates with the chamber above, 
a register is fixed, which may be opened or closed 
at will. The air enters through the register, is 



224 OBSTETRICAL NURSING. 

heated by passing over the hot stone jars, moistened 
by the wet sponges in the space between the upper 
and lower chambers, and finds its exit from the 
chimney, in which it keeps the little wheel revolv- 
ing. The motion of this wheel indicates whether 
the circulation of air within the couveuse is perfect 
or not. A thermometer fastened to one side of the 
interior of the box assists in the regulation of the 
temperature, which should be kept at from 85 ° to 
95 Fahr., according to the indications in each 
case. A frame containing a pane of glass forms 
the top of the box. Through this the record of 
the temperature and the condition of the child can 
be watched.* 

The following directions for the use of the cou- 
veuse are given by Dr. Auvard, who superintended 
its introduction into the Maternite, at Paris : — 
Directions -p Q k ee p U p an even temperature, one of the 

stone jars should be refilled every hour, hour and 
a half, or two hours. 

The apparatus being more difficult to heat when 
it stands in a draught of air, it should be placed so 
as to avoid this. 

Should the temperature rise too high, the cover 

* Dimensions of couveuse for a single infant; Width, 36 cen- 
timetres; length, 65 centimetres; height, 55 centimetres. For 
twins, a larger case is necessary, which holds a correspondingly 
greater amount of hot water. 



THE AILMENTS OF EARLY INFANCY. 22 5 

may be slipped down a little, so as to allow of the 
entrance of air from above, or the inferior register 
may be opened so as to admit a larger quantity of 
air. The partial closure of the register so as to 
admit less air would help to raise the temperature 
when it tends to fall below the desired point, as 
also would the addition of hotter water to the jars. 

The child should be placed in the upper com- 
partment of the couveuse as in its cradle, being 
removed simply for nursing, its bath, and toilette. 
When removed from the couveuse, care should be 
taken to have the temperature of the room suffi- 
ciently warm. Auvard sets this temperature at 
61.2 . We should be inclined to require a higher 
temperature, as from yo° to 75 ° Fahr. 

The length of time the child remains in a cou- 
veuse will vary from fifteen days to thr.ee weeks, a 
month, or even more. It should not be removed 
permanently until it has acquired sufficient vigor 
to live in the ordinary atmosphere of the apartment. 
To accustom the child to this atmosphere, it should, 
as it grows stronger, be removed for an hour at a 
time from the couveuse during the warmest part of 
the day. 

It is best to continue the use of the apparatus at 
night for some time after the child becomes accus- 
tomed by day to removal from the couveuse, for 
15 



226 OBSTETRICAL NURSING. 

the danger of chilling from changes in the atmos- 
phere is greater at night. 

Auvard recommends the use of the couveuse in 
all cases where the vitality of the child is enfeebled 
either by external causes, as cold, or internal 
causes, as prematurity, congenital feebleness, cya- 
nosis, or " blue disease," wasting, or other general 
maladies enfeebling to the new-born. 

To overcome the difficulty in the management 
of this couveuse, owing to the necessity for the fre- 
quent removal of the hot water jars, Auvard has 
devised an improvement, which is shown in Figs. 
31 and 32. 

A cylindrical reservoir of metal takes the place 
of the hot-water jars in the lower compartment of 
the couveuse. This reservoir is filled by means of 
a metallic funnel fastened to one end of the box 
and communicating with the cylinder through a 
metallic tube. 

The overflow of the cylinder is provided for by a 
curved metallic tube at the lower part of the cylin- 
der beneath the inlet through which the reservoir 
is filled. 

The air enters by a register on one side of the 
couveuse instead of at the end, as in Tarnier's 
apparatus. The other portions of the apparatus are 
the same as Tarnier's. 



THE AILMENTS OF EARLY INFANCY. 



227 



The metallic cylinder is capable of holding ten 
litres of liquid (a litre is a little over a quart). To 
start the apparatus, about five litres of boiling 
water should be poured in, after which three litres 
may be poured in every four hours. When ten 

Fig. 35. 




Auvard's Couveuse (Interior View).* 



litres are contained in the cylinder, the overflow- 
pipe carries off the excess. Auvard suggests 
having two vessels, capable of holding three litres 
each, keeping one under the escape-pipe and the 



* Archives de Tocologie. 



228 



OBSTETRICAL NURSING. 



other over the fire, reheating the water in the ves- 
sel filled by the escape-pipe and having it in readi- 
ness for the next change. The two vessels may 
be thus used alternately, and but little time con- 
sumed in the heating of the apparatus as compared 
with that required in the use of Tarnier's invention. 

Fig. 36. 



c§> 




Auvard's Couveuse (Exterior View). 



To empty the cylinder, a rubber tube is attached 
to the escape-pipes, by which it is made to act as a 
siphon — a small quantity of water poured into the 
cylinder through the funnel being sufficient to start 
the liquid. 



THE AILMENTS OF EARLY INFANCY. 



229 



Before the couveuse was known premature Cotton 

, . . - , swaddling. 

babies were swaddled in cotton, in order to be kept 
sufficiently warm. The directions for doing this 
are as follows : — 

Take a square baby-blanket and place it diagon- 
ally on the table or bed. Turn down one corner 
for four inches distance, to come up over the 
baby's head. Spread over this blanket a lap of 
raw cotton. Have the baby's napkin and binder 



Fig. 37. 




Swaddled Baby. 



on and a flannel undervest. Make a cap out of the 
cotton, fitting it over the baby's head and bringing 
it down well under the chin. Then roll the baby 
up in the cotton lap. Bring the blanket around 
this firmly, so as to hold it; the portion of the 
blanket on the baby's right being brought over and 
tucked in on the left side, the portion on the left 
being correspondingly folded over toward the 
right. The corner of the blanket left at the feet is 



23O OBSTETRICAL NURSING. 

then folded up over the front, and the whole held 
in place by means of a strip of muslin bandage or 
ribbon. The bandage is first applied beneath the 
chin, crossed under the back, again crossed in front, 
the ends being brought forward to fasten in a bow- 
knot at the feet. 

The great disadvantages of this method may be 
seen in the restriction it gives to the movements of 
the child's limbs and the difficulty of determining 
when the child's napkin needs changing, also the 
frequent exposure of the child during these changes 
to the ordinary atmosphere. 

An ingenious method of maintaining the body- 
heat of a baby, and one readily accomplished in 
any household, is described as follows by Dr. Rey- 
nolds : — 

"A large basket should be thickly lined with 
heated blankets or other flannels. A number of 
bottles, filled with very hot water, should be so 
arranged around the sides of the receptacle that 
they can be removed and reinserted without dis- 
turbance of the infant. The child is wholly covered, 
with the exception of its face, with well-warmed 
cotton-batting, and is laid between the bottles ; and 
the cradle is then covered with a thick blanket, a 
space at the end which corresponds to the child's 
head being left open to permit the entrance of air. 
A thermometer should be laid beside the child ; 



THE AILMENTS OF EARLY INFANCY. 23 I 

and one or more of the bottles should be refilled 
with hot water whenever the temperature is seen 
to fall below 8y° F. J he water should not, on the 
other hand, be so hot as to raise the temperature 
of the contained air much above 90 F." 

If the baby be .very weak, it may be necessary 
to stimulate it for two or three days by giving it a 
drop or two of brandy, with or without a drop of 
aromatic spirit of ammonia, in a teaspoonful of 
warm water once in two hours. 

The length of time a premature baby should be 
kept in its close quarters is dependent upon the 
progress it makes, or until the gain in weight and 
strength brings it up to the standard of a baby 
at full term. A seven-months child, if strong 
enough, may be dressed when it is four weeks old 
and allowed to nurse. Great care, however, must 
continue to be exercised until the child reaches full 
term. 

The skin of a premature baby should be well protection 
greased after every bath, or some oil, as cotton or ° 
sweet oil, may be used, and will serve the double 
purpose of protecting the skin and giving nourish- 
ment by absorption. 

The child should be fed every hour. As it is Food. 
usually too weak to suck, it is safer to feed the 
baby with a spoon or with a dropper, to make sure 



232 OBSTETRICAL NURSING. 

of its obtaining a sufficient amount of food. From 
one to two teaspoonfuls should be given every 
hour. Breast milk is, of course, the best. It may 
be drawn from the mother's breast and fed to the 
child while warm. The nurse should introduce 
her little finger into the child's mouth and allow 
the milk to trickle slowly down the finger, so as to 
enter the mouth drop by drop, while the child 
sucks the finger. Should the mother have no milk, 
the first week's feeding recommended by Dr. Starr, 
or sterilized peptonized milk diluted two thirds 
with boiled and filtered water, should be used — if 
no wet-nurse can be had as a substitute. 

Should the baby drink badly and throw up a 
Gavage. large proportion of the liquid given to it, " gavage " 
may have to be resorted to. The physician must 
authorize the nurse to carry this out, for she should 
never undertake it otherwise. The directions for 
practicing gavage, as given by Dr. Louis Starr, are 
as follows : — 

The apparatus used is quite simple, being nothing 
more than a urethral catheter of red rubber (No. 
14-16, French), at the open end of which a small 
glass funnel is adjusted. The infant upon whom 
gavage is to be practiced is placed on the knee, 
with its head slightly raised ; the catheter, being 
wet, is introduced as far as the base of the tongue, 



THE AILMENTS OF EARLY INFANCY. 233 

whence, by the instinctive efforts at swallowing, it 
is carried as far down as the oesophagus (or gullet) 
and into the stomach. 

The liquid food is next poured into the funnel, 
and by its weight soon finds its way into the 
stomach. After a few seconds the catheter must be 
removed, and here is the great point in the opera- 
tion ; it must be removed with a rapid motion and 
at once, for if it be withdrawn slowly all the food 
introduced will be vomited. 

Mother's milk is the best for gavage, as at any 
time, but other kinds of food may be used. The 
amount given and the number of meals will vary 
w r ith the age and strength of the child. From a 
teaspoonful to a dessertspoonful at one time is 
sufficient for a very young child, given every hour. 
Too much food would produce indigestion. As 
the child grows stronger this mode of feeding may 
be made to alternate with nursing. Diluted steril- 
ized milk peptonized may be used for the alternate 
feedings. 

Colic is a very troublesome affection of infancy. Colic. 
It corresponds to the dyspepsia of grown people, 
and indicates that the food is either improper in 
quality or quantity. A colicky cry is a sudden, 
sharp cry, the baby drawing up its feet and legs at 
the same time. The feet are generally cold, and 
one indication for treatment is to w T arm them ; 



234 



OBSTETRICAL NURSING. 



Spice 
plaster. 



warm socks or woolen stockings should be worn, 
or hot bottles applied to them. 
Counter- The abdomen should also be kept warm by the 

irritation g x J 

and warmth, application of heated flannels, or a spice poultice, 
wrung out in hot whisky, or a flaxseed poultice, 
and kept applied until the baby gets relief. 

To make a spice plaster, a teaspoonful each of 
ground allspice, cloves, cinnamon, ginger, and cay- 
enne pepper, with four teaspoonfuls of flaxseed 
meal, may be quilted into a bag of flannel, 4x8 
inches, which will fit entirely over the baby's abdo- 
men. When the spicy smell is lost the plaster is 
no longer good for use. 

Warm oil rubbed gently in over the abdomen for 
ten to fifteen minutes at a time, will often give relief 
by leading to the expulsion of the wind causing the 
pain. 

If the application of heat is not sufficient, anise- 
seed tea should be given. It is made as follows : — 

Over a half-teaspoonful of anise-seed pour a half- 
teacupful of boiling water. Allow it to steep a 
few minutes, until the water tastes strongly of the 
anise-seed. A half-teaspoonful of this may be 
given warm every ten minutes until the baby has 
had four doses. This brings up wind from the 
stomach, and thus gives relief. Simple hot water 
will help in the same way should anise-seed not be 
on hand. Catnip tea may be made and used accord- 



on 

inunction. 



Anise seed 
tea. 



THE AILMENTS OF EARLY INFANCY. 235 

ing to the same directions. These teas are preferred 
to the drop doses of gin so frequently given. 

Frequent stools do not always indicate diarrhoea. Frequent 

. . . stools. 

For the first six weeks of its life a child averages 
three or four movements every twenty-four hours, 
after which it has about two a day until it is two 
years old. 

A natural passage for an infant would be of a 
mushy consistency and a yellow or orange color. 
It should contain no curds. Bottle-fed babies have 
whiter and more offensive stools than breast-fed 
babies. 

In diarrhoea there is a change in consistence or 
appearance. A liquid stool, or one colored green 
or white or like putty would be abnormal. The 
presence of curds also would show an inability to 
digest the food properly. 

If, therefore, these curds exist in the stools, or the ^ Iodif j c r a - 

' ' > tion 01 iood. 

matters vomited be curdy, the indication would be 
to use some alkali or a small quantity of some 
thickening substance, as barley-water, gelatine, or 
one of the prepared foods intended to serve the 
same purpose, or the milk may be peptonized. 

Lime-water is the alkali most usually employed. Lime-water 
Lime-water contains but about half a grain of lime 
to the fluidounce of water, so that at least a third 
of the feeding should be lime-water where it is used 
to correct indigestion. To make lime-water apiece 



236 OBSTETRICAL NURSING. 

of lime about the size of the fist should be placed 
in an earthen vessel ; about three or four quarts of 
water may be poured over this, strained thoroughly, 
and then allowed to settle. The water should be 
used only from the top of the vessel. It is better 
to filter it before use. The vessel may be kept filled 
with water so long as any of the lime remains in it, 
when it will be necessary to add more lime. 

When lime-water cannot be obtained, a small 
powder of baking soda — three or four grains — may 
be added to the nursing-bottle. These rules apply 
when the baby is artificially fed. Should the baby 
be nursing the breast a teaspoonful of lime-water 
mixed with an equal quantity of boiled and filtered 
water may be given it before each time it is put to 
the breast. 

Of the thickening substances used to help in the 
digestion of food, barley-water is one of the best. 

wafeT To make barley-water a gill of boiling water should 
be poured over a teaspoonful of washed pearl bar- 
ley, freely ground in a coffee-mill and boiled for a 
quarter of an hour, then strained. It should be 
mixed with milk in the proportions required, two- 
thirds, a half, or one-third. 

Gelatine. Gelatine is sometimes used instead of barley- 

water. A piece an inch square of plate gelatine is 
put into a half tumblerful of cold water and allowed 
to stand about three hours. This mav then be 



THE AILMENTS OF EARLY INFANCY. 237 

turned into a teacup and set in a pan of hot water 
and boiled. The gelatine thus dissolves, and when 
allowed to cool, forms a jelly, of which one or two 
teaspoonfuls may be added to a feeding. 

Of the various kinds of ''infants' food," those inj" fen j 8 \, 

7 ' foods. 

which the starch has been made into dextrine or 
grape sugar are the best. " Mellin's Food" and 
" Horlick's Food " belong to this class. A tea- 
spoonful of these dissolved in a little hot water — 
about a tablespoonful — may be added to the milk 
for the feeding. These starch foods cannot be well 
borne by a child before it is five or six months old, 
as a rule.* 

Condensed milk contains a large proportion of Condensed 
sugar, hence tends to make fat. It is not as nour- 
ishing as many other forms of food. Babies fed on 
it, though large, are generally far from strong, and 
are very apt to suffer from indigestion. 

A careful regulation of the diet, as suggested by Dr. Broom- 

sill's 

Dr. Anna Broomall, for the early weeks of infancy, dietary. 
with the addition of barley-water, lime-water, or 
gelatine, as indicated, in place of plain water, has 
been found most satisfactory in the care of infants 
in the Woman's Hospital. The use of water alone 

* The prepared foods are not to be recommended, notwithstanding 
their efficacy in certain cases. Made by the quantity — their com- 
position is of necessity often uncertain, and they must frequently be 
stale as obtained for use. 



238 OBSTETRICAL NURSING. 

as a diluent is preferred. When curds are per- 
sistently found in the stools, it is sometimes of 
advantage to slightly thicken the milk by the 
addition of a little prepared wheat flour, barley, 
oat-meal, or Graham flour. 

In using wheat the following recipe may be 
employed : Tie a pint of dry wheat flour into a 
piece of stout muslin and boil nine hours ; scrape 
off the outer crust and the inside will be found to 
be a dry ball ; grate this as needed and add about 
two teaspoonfuls to a pint of water, which when 
boiled may be used in diluting the child's milk in 
the proportion desired, instead of using plain water. 
After the sixth month, four teaspoonfuls may be 
used in place of two. Dr. J. Lewis Smith recom- 
mends allowing the flour, tightly tied up in a bag, 
to stand under water for about a week, the water 
being allowed occasionally to boil during this time. 
The flour is thus rendered more digestible. 

Ground barley, oatmeal, or Graham flour may 
similarly be boiled in water in the proportion of a 
dessertspoonful to the pint. An equal quantity of 
milk may be poured in while the water is boiling, 
and the whole may be boiled together from about 
twenty minutes to a half-hour and then strained. 
An ounce of cream and a little milk sugar may 
be added to this. Dr. Keating recommends this 
preparation as excellent for an infant after its 



THE AILMENTS OF EARLY INFANCY. 239 

fourth month, when he considers that it is best 
to make the use of the bottle alternate with the 
breast in the feeding of an infant, especially if the 
mother is not very strong. 

If she has substituted the bottle for some of the Weaning. 
feedings as early as at the age of six months, the 
child will not suffer from the process of weaning. 
In fact, a child often weans itself, refusing to take 
the breast milk during the later months. 

When the child is very weak and vomits con- Substitutes 

' for 

stantly — milk, especially, seeming to disagree with miik-foods. 
it — some of the following measures may be resorted 
to : small and repeated quantities of barley-water, 
gum-arabic water, or wine-whey may be used, a 
teaspoonful every half-hour or hour ; sometimes the 
white of an egg may be shaken up in a bottle of 
warm w T ater and a couple of grains of lactopeptine 
or Fairchild's liquor pancreaticus may be added, 
with a little milk sugar, and this may be given the 
child in teaspoonful doses ; as the child's stomach 
grows stronger, teaspoonful doses of peptonized 
milk may be tolerated. No child should be fed too 
continuously on the prepared foods alone. Fresh 
milk should be used whenever possible, as a disease 
known as scurvy often arises from long use of stale scurvy, 
preparations. 

An occasional drink of water is essential to a 
baby, however young. The water should be boiled 



24O OBSTETRICAL NURSING. 

and kept air-tight to be free from germs. From a 
teaspoonful to a tablespoonful may be given occa- 
sionally during the intervals of nursing. Infants 
under four months of age should be fed upon milk 
alone in some of its forms. 

Miik-foods. When breast milk cannot be had and cows' milk 
seems to disagree, some of the " milk foods," as 
Carnrick's Soluble Food, Anglo-Swiss, Gerber's, 
or American Swiss, may be tried. Care must be 
taken to see that the preparations are fresh before 
using. 

Farinaceous The farinaceous foods, as Blair's Wheat, Hubbell's 

foods. . ' ' 

Wheat, Imperial Granum, and the home-made pre- 
parations before described, should not be used until 
the child is at least four months old. 

If in the use of the latter the child's bowels 
become constipated or it suffers from colic or is 
restless at night and loses its appetite, some of the 

Liebig Liebig foods may be tried, as Mellin's, Malted Milk, 
Lactated Food, etc. The directions for the use of 
these foods come with the various packages con- 
taining them and are readily. followed. Milk, as a 
rule, in some form or other, should be used in 
making up these preparations, otherwise they will 
not contain sufficient nourishment. 

Period of A mother, although healthy, should not nurse 

nursing. ° J 

her child longer than for one year, as her milk 
does not contain sufficient nourishment. 



tion. 



THE AILMENTS OF EARLY INFANCY. 24 1 

Constipation is not an infrequent occurrence in Constipa- 
infancy. Its management consists principally in 
the use of mechanical irritants for stimulating the 
bowels ; thus, a soap suppository, an injection of 
warm oil or water, gentle friction over the bowel, 
especially following the direction of the large bowel 
from right to left, are among the most effective 
methods for overcoming this condition. 

The soap suppository is made by taking a piece 
of Castile soap, about one inch long, and shaping it 
into a cone and making it very smooth, so that it 
will not be larger around than the end of the little 
finger. This should be gently insinuated about half 
its length into the bowel and held in the opening 
until it excites the bowel to act. 

The bowel injection may be given by means of 
the single-bulb syringe, known as the " eye and 
ear syringe/' The bulb holds about two table- 
spoonfuls of liquid. This may be warm cotton-seed 
oil, sweet oil, or warm water. The nozzle used 
should be small, smooth, and well oiled. It should 
be very carefully introduced into the bowel, being 
directed a little to the left side, and the bulb gently 
squeezed to force the contents into the bowel. It 
is best that the liquid should be retained for a little 
time before it is forced out. The keeping up of a 
slight pressure over the entrance to the bowel for 

a short time will aid this. 
16 



242 



OBSTETRICAL NURSING. 



Rubbing the abdomen for about ten minutes 
(either with or without oil) in the direction of the 
large bowel — that is, upward on the right side as 
far as the border of the ribs, then across to the left 
side and down this side to the pelvis, is often effi- 
cient in overcoming constipation. 



Fig. 38. 




Single-bulb Syringe "(Starr). 

Of medicinal measures, glycerine, gluten, or 
cacao-butter suppositories may be resorted to, or 
manna may be given, a piece the size of a pea in the 
child's milk one, two, or three times a day, or a 
spoonful of water sweetened with dark-brown sugar. 



THE AILMENTS OF EARLY INFANCY. 243 

Should the child be on artificial food, oatmeal-water 
may be substituted for barley-water in the prepara- 
tion of the food. 

Babies vomit very easily, because their stomachs vomiting. 
are placed more vertically in the body than when 
they grow older, and over-feeding will cause them 
to bring up the amount in excess of what the 
stomach can hold. This vomiting is, of course, not 
serious. Should the vomited matter be sour and 
curdy, the child seem to suffer from nausea, weak- 
ness, or fever, it indicates a condition of indigestion 
which should receive attention. The management 
would largely consist in the regulation of the 
quality and the quantity of the food, as has just 
been said. 

Thrush is a disease due to want of care of the Thrush. 
baby's mouth. If milk be allowed to collect on 
the tongue, it sours, and the presence of this acid 
favors the development of thrush, which is really a 
vegetable parasite. White patches may be seen on 
the soft palate, inside the cheeks, lips, and tongue. 
The attempt to rub off these patches causes bleed- 
ing. Gastric catarrh and diarrhoea usually accom- 
pany this trouble. Care in cleansing the child's 
mouth after each nursing will prevent the occur- 
rence of thrush. Its treatment consists in the use 
of an alkaline wash, as borax and water (twenty 



244 OBSTETRICAL NURSING. 

grains to the ounce), or some antiseptic wash pre- 
scribed by the physician.* 

"Red gum." " Red gum " is an eruption which comes out over 
the baby in the first or second week of its life. 
Sometimes these little points of elevation on the 

"u^i h,i ' te s ^ m are white. The eruption is then called " white 
gum." These eruptions are due to changes in the 
skin and irritation from exposure to air, and are not 
serious. They rarely last over a week. 

Blisters. The occurrence of little blisters on the child's 

body, especially on the palms of the hands and soles 
of the feet, is a matter of more moment and should 
at once be brought to the attention of the physi- 
cian, as also should sores around the finger nails. 
These indicate a condition of the blood for which 
the use of remedies prescribed by the physician 
will be necessary. 

rhaa?-the Sometimes a whitish, glairy discharge comes 

whites." f rom the privates of little girl babies. This is sim- 
ply the matter found there at birth. Occasionally 
a little blood may be mixed with it, the result of an 
abrasion in the vagina, and may last a day or two. 
The nurse need not be afraid to remove this matter ; 
in fact, if left, it causes irritation of the skin. 

Urine. A healthy baby usually wets its napkin very fre- 

* Boracic acid (ten grains to the ounce of water) is very good. 
A teaspoonful of this may be swallowed by the child occasionally. 



THE AILMENTS OF EARLY INFANCY. 245 

quently — It may be, every hour during the day, 
and four or five times at night. Sometimes several 
hours may pass and yet the napkin remain dry. 
Either of these conditions may exist in health, 
being dependent largely upon the weather, the 
food, etc. If urine is not passed for twelve hours, 
the condition should be reported. 

The nurse may try to make the baby urinate by 
using fomentations over the bladder and kidneys 
before reporting the matter to the physician. 

The skin of new-born babies is soft and thin, andcareof 

skin in ex- 
apt to become sore, especially when two surfaces coriations - 

rub. First, a little crack is noticed, next day this 
will have widened until, sometimes, a large surface 
is left bare. To prevent this, proper care of the 
baby from the very beginning is important. Never 
use soap. Use warm water in washing it, either 
plain w T arm water or water w r ith sufficient powdered 
borax to make it soft, and wash the part very care- 
fully ; wipe or mop carefully with a soft cloth. 
Then, to prevent further rubbing of the parts, par- 
ticularly if the skin be broken, use a piece of patent 
lint or soft Canton flannel, with some salve, as zinc 
ointment, containing twenty grains of boric acid to 
the ounce, spread over it, and carried into the crease 
between the rubbed surfaces. This should be 
changed at least three times a day, or as often as 
the baby soils the napkin. 



246 OBSTETRICAL NURSING. 

sore eyes. Baby's sore eyes generally come about from some 
infection of the eyes through the mother's dis- 
charges at the time of the birth, or in lying-in 
hospitals one baby infects another. Hence, should 
care be taken to cleanse the eyes immediately after 
the delivery with a saturated solution of boric acid, 
or even clean, warm water, they may be prevented, 
as a rule, from getting sore. In many hospitals 
a drop of a two per cent, solution of nitrate of silver 
is dropped into the eyes after douching them well 
with boiled water at 98 F. Should the inflamma- 
tion occur, however, the nurse must remember that 
the affection is contagious, through the- matter 
which forms in the eye. This matter is capable of 
setting up an inflammation elsewhere, as when a 
towel used about the eyes may produce a similar 
inflammation about the privates ; a scratch or 
wound in the hands may be affected by it. The 
discharge from affected eyes is greenish- white. 
The poison it contains is not destroyed by drying; 
it catches and clings to the room, as the poison of 
smallpox. Hence, a nurse's hands should be thor- 
oughly cleansed after washing the eyes, and the 
nails cleaned with a nail-brush. The cloths used 
in washing the eyes should be burned at once after 
using. The greatest precautions must be taken not 
to carry the poison. The nurse's chief care, apart 
from preventing the spread of the trouble, in such 



THE AILMENTS OF EARLY INFANXY. 247 

a case, would be to keep the eye or eyes free of the 
discharge by frequent cleansings with warm water 
gently syringed into the eye from the inner toward 
the outer angle, the lids being held everted by their 
gentle separation by the thumb and finger of one 
hand.* This washing may need to be done every 
hour. The baby's hands should be kept down by 
fastening a towel around the child's body, pinning 
it in the back. The baby may be held between the 
nurse's knees and its head inclined over a basin, 
which will receive the water from the washing. 
Another basin should contain the clear water to be 
used. Should only one eye be sore, in placing the 
baby in its crib, or laying it down at any time, the 
nurse should be careful to place it with the sore 
eye down, so that any discharge from it may not 
enter the other eye. Any further irritation, as of a 
strong light, should be prevented by keeping the 
baby in a darkened place. Want of attention in 
these cases may cause a child the loss of its sight. 
A room occupied by a baby with sore eyes must 
afterward be carefully disinfected. 

Snuffles, or a cold in the head, shown by watery Snuffles. 
eyes, sneezing, stopping up the nose, hence diffi- 
culty in nursing, should be managed by keeping 
the nose cleaned out by means of soft linen twisted 

* A warm saturated solution of boracic acid is even more 
efficacious. 



248 



OBSTETRICAL NURSING. 



Discharge 
from ears. 



Enlarge 
ment of 
breasts. 



into a cone, greasing the nose well afterward with 
a little oil by carrying it up the nostrils on a twist 
of cotton, greasing the outside of the nose between 
the eyes, and keeping the baby warm. If the baby 
has no hair, the head may be kept warm by a little 
mull (or in winter thin flannel) cap. 

Running at the ears is generally very serious in 
new-born babies, especially when the discharge is 
matter or blood. Some trouble with the brain may 
be indicated, hence the physician should be told of 
it as soon as it is noticed. Of course, the discharge 
entering the ears at the time of the birth should be 
carefully excluded from this disorder. The breasts 
of new-born babies often swell. Generally this 
occurs about the seventh day or during the second 
week. Occasionally they gather, and must then be 
lanced by the physician. Nothing should be done 
for this swelling, except to see that the clothing is 
Moulding of loose. It disappears in a few days, as a rule. The 
same may be said of swellings on the head or about 
the face, which are due to pressure during the 
birth. One form of scalp tumor may last several 
weeks before its entire disappearance. The latter 
is the result of temporary injury to the bone, and 
not simply the ordinary swelling which comes from 
interference with the circulation of the blood in the 
soft tissues of this portion of the scalp. 

A child may be born with some deformity, as 



head 



Scalp 
tumors. 



Deformi- 
ties. 



THE AILMENTS OF EARLY INFANCY. 249 

hare-lip, or cleft-palate, or club-foot, or extra fin- 
gers and toes, or there may be some malformation 
about the external organs of generation or the 
bowel. Whatever the deformity may be, the nurse 
should avoid letting the mother know anything 
about it until the physician has told her of it. The 
shock produced by the knowledge may do the 
mother much injury; hence the physician should 
bear the responsibility of making the announce- 
ment. A nurse will need considerable tact in 
managing this, as the mother is apt to ask to see 
her baby very soon after its birth. An excuse may 
be made by stating the necessity for washing and 
dressing the child first, or it may be asleep and 
the nurse hesitate to disturb it. 

Quite frequently the bridle beneath the baby's Tongue, 
tongue is too short, and interferes with the free 
movement of the tongue. This is called " tongue- 
tie." It may prevent the child's nursing, and thus 
interfere with its nutrition. If the baby can extend 
the tip of the tongue beyond its lips, it is not prob- 
able that there will need to be anything done, as 
the baby ought to be able to suck a good nipple 
with ease. If the nurse should introduce the tip 
of her little finger into the baby's mouth and allow 
the child to draw on it for a few minutes, she can 
tell whether the act of sucking can be properly 
accomplished. Should it not be able to suck, the 



tie. 



25O OBSTETRICAL NURSING. 

attention of the physician should be called to the 
matter, as the bridle will have to be nicked — an 
operation following which there may be consider- 
able loss of blood, hence it should not be attempted 
except by a physician. 
fVom d thf Bleeding from the cord or navel string may 

cord. occur within a few hours after birth. It may 

be that the cord has not been tied sufficiently 
tight, or there may have been a very thick cord, 
which, in shrinking, has loosened the ligature. If, 
after tying, the cord has been looped back upon 
itself and tied in a single double bow-knot, this may 
be untied by the nurse and fastened more tightly, 
so that the bleeding may be controlled, or another 
ligature may be thrown around the cord a little 
nearer the body of the child than the first one. 
Should this not check the hemorrhage, the nurse 
should hold the cord firmly between thumb and 
finger, making compression until the physician, 
who should be sent for, arrives.* 
"Failing" The cord commonly falls off about the fifth day. 

of cord. J m * 

The process of ulceration, by which it falls off, 
leaves an open surface on the child's body which 

* Bleeding from the base of the stump after the cord has fallen 
is a more difficult condition to manage. The physician needs 
sometimes to control the hemorrhage by a ligature drawn beneath 
transfixion pins. The nurse must keep up pressure over the site 
until the doctor comes. 



THE AILMENTS OF EARLY INFANCY. 25 I 

• 

offers an avenue for septic infection. Great care 
should therefore be taken that the nurse's hands 
and anything else that comes in contact. with this 
surface are perfectly clean. Should any moisture 
exist about the stump, the use of the antiseptic 
powder of salicylic acid and starch, before spoken 
of, or some other drying powder of the kind, is 
indicated. It is necessary, also, to see that the 
dressing used is thoroughly antiseptic. Whenseptic 
infection does exist, it shows itself irr the occurrence navel! " 
of inflammation around the navel or some other 
part of the body ; the child loses flesh, has fever, 
becomes puny and emaciated, and abscesses form 
in various places. In the majority of cases it dies, 
not having sufficient vitality to survive the poison- 
ing.* 

The physician will, of course, prescribe the treat- 
ment for such a child ; the nurse will be required 
to see that these directions are faithfully carried out, 
and especially that the child gets all the nourish- 
ment and stimulation required. 

Umbilical vegetations are either soft, jelly-like Umbilical 

-. -, . , , , , vegetations. 

growths, or, which is more common, hard protuber- 
ances sometimes the size of a hickory-nut. They are 
not painful and seldom bleed. The physician some- 



* Sometimes the inflammation takes on the character of 
erysipelas. 



252 



OBSTETRICAL NURSING. 



Jaundice of 
infancy. 



True 
jaundice. 



times removes them by ligature. The softer forms 
maybe touched with caustic and thus made to shrink. 

A peculiar yellowish coloration of the skin is to 
be noticed with babies a few days after the birth. 
This disappears, as a rule, by the end of the second 
week, and is due to changes in the circulation. 

Should the jaundice be very marked and seem to 
persist warm baths once or twice a day, with gentle 
friction over the liver with soap liniment, helps, with 
free action of the bowels, to overcome the condition. 
Jaundice of the new-born baby is sometimes 
the result of disease of the liver. The color is then 
very marked. The baby grows thin rapidly and 
appears sick. The stools are apt to be clay-colored. 
When the child is suffering from blood-poisoning, 
the peculiar coloration of the skin is due to this 
cause. 

Buhl's disease is an obscure disease of new-born 
babies, thought to be due to fatty degeneration of 
the internal organs. It results fatally, as a rule, 
within the first few days. There is a tendency to 
hemorrhage from various parts of the body. 

In some families known as "bleeders," the ten- 
dency to hemorrhage may be transmitted to the 
child, particularly if it be a boy. It is necessary to 
watch for any such tendency very closely. 
Convulsions. Convulsions may occur in very young infants at 
varying periods after their birth, according to the 



Buhl's 
disease. 



Bleeders. 



THE AILMENTS OF EARLY INFANCY. 253 

.cause which excites them, as, injury during labor, 
indigestion, brain trouble, or other causes. The 
convulsive seizure is generally preceded by twitch- 
ings of the limbs, a rolling-up of the eyeballs, so 
that a large part of the whites of the eyes is seen, 
the thumbs are drawn into the palms of the hands, 
and the fingers tightly clasped over them, or the 
toes may be turned upward or drawn downward. 
During the convulsion the child grows rigid. 

When the attack comes on the nurse should 
quickly undress the child and place it in a warm 
bath. A tablespoonful of mustard added to the 
water will help to stimulate the skin, and the con- 
vulsion will gradually subside. The child, on its 
removal from the bath, may be wrapped in a heated 
blanket, and allowed to perspire freely. On the 
recurrence of the convulsion, the same measure of 
placing the child in the bath should be resorted to, 
until the physician comes and institutes such other 
treatment as he may think proper. 

Bruises, the result of falls or blows, should be Bruises. 
treated by the repeated application of hot com- 
presses. This will relieve pain and prevent swell- 
ing, and the black and blue coloration of the skin 
which would otherwise result. 

The occurrence of a fall or blow should be care- ^^ s s and 
fully reported by a nurse, as the child should be 
carefully examined for the discovery of any injury 



254 OBSTETRICAL NURSING. 

the serious consequences of which may be averted 
by prompt treatment. The occurrence of paleness 
or vomiting after any such accident is a serious 
symptom and should receive immediate attention 
by the physician. 

Fever. A hot, dry skin may accompany various of the 

disorders of infancy, notably inflammatory condi- 
tions of the digestive organs and of the lungs. 
The normal temperature of a new-born baby is 
90 Fahr., the pulse 140, the respiration 44. 

Should the child seem to be ailing, its tempera- 
ture should be taken. A clinical thermometer may 
be held the requisite number of minutes in the 
groin or in the folds of the neck. Some slip the 
bulb of the thermometer into the rectum. Should 
the temperature be raised, the pulse rapid, and the 
respiration hurried and difficult, some lung trouble 
probably exists. Pneumonia is a very common 

Lung disease with infants. A catch in the breath, noisy 

troubles. t # * 

breathing, a distention of the nostrils on taking an 
inspiration, would indicate the same thing. % The 
frequent rubbing of the chest with some counter- 
irritant liniment, as St. John Long's liniment, the 
use of the cotton-jacket for the protection of the 
chest, and, if the child is very feverish, the use of 
a drop of sweet spirits of nitre in a teaspoonful of 
water once in two hours, will constitute the nurse's 
management of the case until the doctor has seen 



THE AILMENTS OF EARLY INFANCY. 255 

the baby and laid down his plan of treatment. The 
cotton-jacket is made by taking a high-necked, long- Cotton- 

jacket. 

sleeved merino vest a size or two larger than would 
be needed by the baby for ordinary wear, opening 
it down the front, and fastening tapes an inch or 
two from each edge in front, by which the jacket 
may be closed. The inner surface of this vest, 
back and front, should be quilted with sheep's wool 
or cotton-batting, the outer surface with oiled silk 
or oiled muslin. This makes a very warm covering 
for the chest. 

Cyanosis, or "blue disease" comes from the Cyanosis or 

r 1 r • 1 • i 1 " blue 

imperfect closure of an opening which exists in the disease." 
heart before birth. The baby is called a " blue 
baby," and is very delicate in consequence of this 
imperfection in its circulation. Such babies gener- 
ally die, if not during infancy, some time during 
early childhood. With great care they sometimes 
live, and the opening in the heart gradually closes 
up. The special care required is to keep the child 
warm and to handle it very carefully, so that it may 
be subjected to no jar or nervous fright. The child 
should be kept lying on its right side, or on its 
back, in order that there may be as little interfer- 
ence as possible with the action of the heart, and 
that the tendency of the blood to flow through this 
opening in the upper chambers of the heart — from 
right to left — may be overcome. 



256 OBSTETRICAL NURSING. 

Rickets. Rickets is a disease of the bones — the result of 

poor nutrition. There is not sufficient deposit of 
earthy matter in the bones, hence they remain too 
soft and are subject to all kinds of distortions in 
consequence of this. The child may be bow-legged 
and is stunted in its growth, curvatures of the spine 
may exist, or an unnaturally large head, known as 
hydrocephalus, or " water on the brain." 

The baby having this disease is very weak, can- 
not hold up its head well, perspires very freely, 
especially about the head. The complexion is very 
white. The baby has constant trouble with its 
bowels, having green stools nearly all the time. 
The opening in the front of the head is depressed 
and the child seems to waste. 

As the baby grows older, unless well cared for, 
the evidences of disease increase, the joints are 
enlarged, the baby cannot support itself on its 
limbs, its teeth are slow in coming, etc. 

The mother can do much for the health of her 
child, while still carrying it, by a careful regard for 
her own general health. After the baby's birth it 
should be kept well nourished, to overcome any 
tendency to this disease. Salt baths, oil baths, 
and the use of tonics ordered by the physician, as 
cod-liver oil, together with careful attention to the 
quality and quantity of nourishment, will do much 
to prevent the progress of rickets. 



THE AILMENTS OF EARLY INFANCY. 257 

The question often arises as to how soon a baby Vaccina- 
should be vaccinated, particularly 'if smallpox be 
prevalent. As a matter of experience, it is found 
that the vaccination does not " take" well before 
the third month, though, if a younger baby is to 
be exposed to the poison, it would be well to have 
it vaccinated. Vaccination should be avoided, if 
possible, when the baby's health is run down from 
any cause, also at the time of teething. A peculiar 
and distressing form of rash sometimes occurs, or 
there is a great deal of inflammation following the 
vaccination, leading the parents to imagine that the 
baby has been poisoned by the virus used. 

An insight into the frailty of human life in its The 

world's 

earliest days proves how much the world owes to debt to 

nurses and 

the faithfulness of mothers and nurses, and should mothers. 
be a stimulus to scientific research in the discovery 
of improved methods for the management of in- 
fancy. 



17 



INDEX 



Abdominal bandages, 78 
belt, 34 

binder, 48, 11 1, 136 
Absence of physician during labor, 

114 
Accidents of labor, 114-131 

of pregnancy, 52-57 
After-birth, care of, 111, 168 

delivery of, 124-125 
After-pains, 195-197 
Ailments of early infancy, 221-257 
Albuminuria, 35 
Analysis of human and cows' milk, 

150 
Anise-seed tea, 234 
Antisepsis, 58-64 

during labor, 98-101, 109 
Antiseptic dressings, 68, 79 

(Garrigues'), 79- 
80 
precautions after labor, 126, 

1 73- 175 
Antiseptics, 65-76 
Anus, 21 
Apparatus for sterilization of milk, 

1 59.. l6 ° 
Application of antisepsis to confine- 
ment nursing, 65-76 
Arrangement of patient's clothing 

during labor, 107 
Articles needed for baby's basket, 88- 
104 
in confinement room, 
78-83, 106 
Artificial breathing, 1 17-122 

feeding of infants, 150-166 
Average length of new-born baby, 
209 
weight of new-born baby, 
- .209 



Avoidance of pressure of foetal head , 

211 
Auvard's couveuse, 227-228 



B. 

Bag of waters, 92 

Bandaging of breasts, 183-186, 189- 

192 
Barley water, 236 
Bathing after delivery, 175 

during pregnancy, 48 

of new-born infants, 132-135 
Bearing-down pains, 93, 107 
Bed-sores, 201 
Bichloride of mercury, 98 
Binder (infant's), 136 
Bladder during lying-in, 175-178 
pregnancy, 33-35 
Bleeders, 252 
Bleeding from cord, 250 
Blisters, 244 

Blood-poisoning, causes of, 65, 66 
prevention of, 66 
Blue disease, 255 
Bowel movements of infancy, 216, 

235 
Breast bandages, 79 

pump, 188 
Breasts, care of, 181-195 

function of, 23 

development of, 27 
Breech delivery, 126 
" Brown line " of pregnancy, 28 
Bruises, 253 
Biihl's disease, 252 



c. 



Caked breast, 187 
Call for nurse, 95 



259 



260 



INDEX. 



Carbolic acid solution, 99 

Care after third stage oflabor, 125-126 
of after-birth, 111 
of breasts in pregnancy, 41 
of breasts in lying-in, 180, 186- 

T 95. 
of infant at birth, 1 16-123 
of napkins, 137 
of new-born infant, 132-144 
of new-born infant's eyes and 

mouth, 71, 138 
of perineum, 115 
of navel cord, 71 
Catheter, use of, during lying-in, 175- 
178 
in pregnancy, 35 
Caul, 117 
Cervix, 21 

Cessation of menstruation, 26 
Changes of clothing, 104, 126 

in urinary organs during 

pregnancy, 33-35 
in weight of infant, 139-140, 
212 
Characteristics of infancy, 209-220 
Chemilette, 43-44 
Chill, 199 

Chloride of lime, 73 
Cleansing of baby's eyes, 71, no 
of catheter, 68 
of mother after labor, in, 

126, 175 
of nursing bottle, 164 
of physician's hands, 101 
of rubber nipple, 165 
Clitoris, 19 

Closure of fontanelle, 211 
Clothing during pregnancy, 42-48 
Colic, 233 
Colostrum, 145 
Company, 108, 170 
Conception, 24 
Condensed milk, 237 
Condy's fluid, 74 
Cone-shaped nipple, 183 
Confinement room, 77 

outfit, 100 
Constant flow of milk, 195 
Constipation, 31, 179, 241 
Convulsions, 56, 128 

of infancy, 252 
Cooking for lying-in patients, 172- 

„ T 73 . ; 
Cotton-jacket, 255 
Couveuse, 222-228 
Cramps during labor, 108 
Creoline, 98 
Cross-bed, 130 



Cry in brain trouble, 215 

in colic, 215 

in lung trouble, 215 

of earache, 215 

of hunger, 215 
Cyanosis, 214 255 



D. 



Daily airing of infant, 166 
Deepened color of vulva, 27 
Deformities of new-born, 248 
Delivery of head, 115 
of body, 116 
Demeanor of nurse, 129 
Dentition, 218 
Depressed nipple, 185 
Depression of fontanelles, 211 
Descent of child, 89 
Development of breasts, 27 
Diarrhoea, 32, 33 
Diet during pregnancy, 49, 50 
Dietary of lying-in, 170, 172 
Discharge from ears, 248 
from vulva, 63 
Diseases due to mould and yeast infec- 
tion, 62, 63 
Disinfection of clothing and bedding, 

75 ' 
of hands, 67 
of rooms, 70, 75 
of water-closets, 76 

Divided skirt, 44 

Double Y bandage of breasts, 190, 192 

Drawing of teeth during pregnancy, 
40 

Dressing of cord, 135 

" Dry labor," 56 



E. 



Earache, 215 

Effects of menstruation on lactation, 
149 
of pregnancy on lactation, 150 
Emergencies of labor, 114 
Enlargement of abdomen, 27 
Equipoise waist, 47 
Etherization during labor, 131 
Examination by physician, 100 

of urine, 35 
Excessive acidity of urine, 34 
Excoriation of vulva, 34 
Exercise during pregnancy, 50 



INDEX. 



26l 



Expulsion of after-birth, 64 

of child, 64 
Expulsive after-pains, 196 



F. 

Facial expression in infancy, 216 
Falling of cord, 250 
Fallopian tubes, 22 
False pains of labor, 90 
Farinaceous foods, 240 
Feeding of infant, 142 

of premature infant, 231, 233 
Fever of infancy, 254 
Figure-of-eight of breast, 184, 185 
First sitting-up after delivery, 205 
Flannel underwear, 48 
Fomentations, 187 
Fontanelles, 211 
Food recipes, 157, 159 
Forced feeding in puerperal mania, 

204 
Fore-milk, 145 
Form of new-born baby, 210 
Fruit diet during pregnancy, 50 



Garrigues' breast bandage, 186 

Garters, 46 

Gathered breasts, 192 

Gavage, 232 

Gelatin, 236 

Genital organs, 18 

Germs, 58, 64 

Gertrude suit, 87 

Graduated nursing-bottle, 162, 163 



H. 

Handkerchief bandage of breast, 188 

Hemorrhage after labor, 126, 128 

during pregnancy, 52, 53 
from rupture of varicose 
veins, 54 

Hemorrhoids, 37, 90 

Hollow nipple, 184 

Hygienic dressing, 43-48 

Hymen, 19 



Imperforate anus, 217 

Improvised sterilizing apparatus, 166 



Incontinence of urine, '33 

Infancy, 221 

Infant's binder, 136, 84 

blanket wrap, 86 
caps, 86 
clothing, 84-88 
crib, 140, 141 
flannel slip, 85 
foods, 142, 156,237 
socks, 86, 138 
undervest, 84,138 

Injuries, 253, 254 

Insufficient milk, 144, 195 

Intrauterine injections, 196 

Involution, 173 

Irritability of bladder, 33 



J. 

Jaundice of infancy, 209, 252 



K. 

Kidneys during pregnancy, 35 
Knitted wool band, 84 



L. 

Labarraque's solution, 74 

Labia majora, 18 

Lactation, 143-147 

Lactometer, 148 

Lancing of breasts, 193, 194 

Language of a cry, 215 

Lateral position during labor, 83 

Laxatives during lying-in, 179, 180 

Leglettes, 45 

Length of new-born baby, 209 

Leucorrhcea, 21, 36 

of infancy, 244 
Liebig foods, 240 
Lime-water, 235 
Lochia, 173 

Lung troubles, 215, 254 
Lying-in, duration of, 173 



M. 

Management of lying-in, 168, 208 
of pregnancy, 31, 51 
Mask of pregnancy, 28 



262 



INDEX. 



Mastitis in infancy, 248 

Meatus urinarius, 19 

Meconium, 137 

Menstruation, 23 

Message to physician, 97 

Methods of reckoning termination of 
pregnancy, 29, 30 

Microscopic examination of milk, 149 

Milk (cows'), 150, 151 
(human), 150 

Milk-foods, 240 

Milk-leg, 201 

Miscarriages, 54, 55 

Modification of infant's food, 235 

Mons veneris, 18 

Morning sickness, 28 

Mother's dress during labor, 78 

Moulding of the head of new-born in- 
fant, 248 

Mushroom nipple, 184 



N, 

Napkins, after care of, 174, 175 
changes of. 109 
for infant, 84, 85 
for mother, 79 
Nightingale wrap, 81 
Nipple bath, 42 

protector, 42, 43, 181, 182 
shape of, 183 
shield, 181, 182 
Nipples, 162 165 

care of during lying-in, 181- 

184 
sore, 181, 182 
Nourishment during labor, 108 
Nurse dress, 95, 96 

report, 197, 198 
Nursing, 145 

bottle, 162 
Nymphae, 19 



Observations of pains, 97 
Obstetrical breast support, 192 
Occlusion dressing, 79, 80 
Odors in lying-in room, 168 
Oil enema, 180 

inunctions, 234 
Order board, 207 
Os uteri, 22 
Outfit for baby, 84, 88 
Ovaries, 22 
Over-distention of bladder, 35 



P. 

Pain during lying-in, 199 

from distention of abdominal 

walls, 39 
in back during pregnancy, 39 
Painful breathing, 214 
Pains of first stage of labor, 93 
Pelvis, 17 

Pelvis, measurements of, 17 
Peptonization of milk, 156, 157 
Perineal pad, 80 
Perineum, 20 

care of, 115 
Poisoning from carbolic acid, 71, 72 
from corrosive sublimate, 72 
from iodoform, 73 
Position during second stage of labor, 
no 
during third stage of labor 
no, 124 
Positive signs of pregnancy, 29 
Powder, 185 
Premature rupture of membranes, 55, 

^9 2 

Prematurity, 221 

Preparation of cows' milk for infants. 
152, 154 
of antiseptic solutions, 

98, 99 
of confinement room, 101 
of double bed, 102 
of patient for labor, 97, 

100 
of permanent bed, 102 
of single bed, 101, 102 
Preparations for labor, 77, 88 

for obstetrical opera- 
tions, 129, 131 
Pressure on foetal head, 210 
Probable signs of pregnancy, 26-29 
Process of labor, 91-94 
Prolapses, 129 

Protection of bed during labor, 82, 103 
of floor during labor, 82, 
103 
Ptomaines, 58 
Puerperal fever, 199 

anemia, 170, 202-204 
ulcers, 200 
Pulsation of fontanelle, 211 
Pulse of infancy, 214 

Q- 

Quantity of food required for infants, 

154 
Quickening, 28 



INDEX. 



263 



R. 

Receptacles needed in confinement- 
room, 105 

Red gum, 244 

Respirations of infancy, 213, 214 

Resuscitation of infant, 117, 123 

Rest for lying-in patient, 168 

Retention of urine, 217 

Rickets, 256 

Rise of temperature during lying-in, 
199 

Rubber nipples, 164 
sheets, 69 

Rules for antisepsis in confinement 
nursing, 67, 71 
for sterilization of milk, 161, 162 

Rupture of uterus, 129 



Salivary glands during pregnancy, 48 

Scalp tumors, 248 

Schultze's method of resuscitating,i2o- 

122 
Scurvy, 239 

Sea-voyaging during pregnancy, 49 
Second stage of labor, 91 
Secretion of tears in pregnancy, 216 
Securing of maniacal patients, 204 
Sepsis during lying-in, 61, 62 
Septic infection of navel, 251 

inflammation of breasts, 193, 

x 94 ; 

Serious symptoms during lying-in, 

199 
Shape of new-born baby's head, 210 
Signs of approaching labor, 89-93 

of pregnancy, 26-29 
Skin of new-born baby, 209, 231, 245 
Sleep after delivery, 168 

of infancy, 213 
Snuffles of infancy, 246 
Soiled clothing after labor, 69, 70, in 
Sore eyes of infancy, 246 

mouth, 216 

nipples, 180-182 
Spasmodic after-pains, 197 
Spice plaster, 234 
Stages of labor, 91, 114 
Sterilization of milk, 159 
Stimulants, 106 

Straight bandage of breasts, 190 
Striae, 28 

Subinvolution, 205 
Surroundings during lying-in, 61-62 



Suspicious signs, 26 
Sutures, 210 
Swaddled baby, 229 
Swelling of breasts of infancy, 248 
of extremities, 37, 89 
of vulva after delivery, 178 
Sylvester's method of resuscitation, 

118-120 
Symptoms of lowered vitality, 215 
Symptoms of poisoning from use of 

antiseptics, 71-73 
Syringe, 83 

single bulb, 242 
System, 104 



Tact, 109 

Tarnier's couveuse, 223 
Teeth during pregnancy, 40 
Temperature of infancy, 114, 255 

of infant's food, 158, 159 
Temporary bed, 102-103 
Testing milk, 147 
Third stage of labor, 91 
Thrush, 63, 64, 243 
Time required for feeding infants, 165 
Tongue-tie, 249 
Training of infants, 142 
Treatment of caked breasts, 187 

of puerperal mania, 203 
True pains of labor, 90 
Twins, 124 
Tying of cord, 123 



u. 

Umbilical vegetations, 251 
Union under-garment, 48 
Urination in infancy, 216, 244 
Urine, acidity of, 34 

examination of, 35 
incontinence of, 33-34 
increased amount of, 35 
in cystitis, 64 
in pregnancy, 33-34 
retention of, 33 
Use of catheter, 176 
Uterus, 21 



V. 



Vaccination, 257 
Vagina, 19 



264 



INDEX. 



Vaginal injections, 53, 69, 111 

Ventilation, 166 

Vernix caseosa, 132 

Viability, 221 

Visitors during lying-in, 70, 170 

Vomiting during labor, 108 
of infancy, 243 
of pregnancy, 41 



w. 

Wash dresses, 96 
Weaning, 239 
Weighing the baby, 139 
Weight of new-born baby, 139 
Wet-nurse, 144 
Wharton's jelly, 136 
White gum, 244 



CATALOGUE No. 7, 



DECEMBER, 1892. 



A CATALOGUE 

OF 

Books for Students. 

INCLUDING THE 

? QUIZ-COMPENDS ? 





CONTENTS. 




PAGE 


PAGE 


New Series of Manuals, 2,3,4,5 


Obstetrics 1©, 


Anatomy, 


. 6 


Pathology, Histology, . . 11 


Biology, 


. II 


Pharmacy, . . . .12 


Chemistry, . 


. 6 


Physical Diagnosis, . . n 


Children's Diseases, 


• 7 


Physiology, . . . . n 


Dentistry, 


, 8 


Practice of Medicine, . n, 12 


Dictionaries, 


8, 16 


Prescription Books, . .12 


Eye Diseases, 


. 8 


?Quiz-Compends? . 14,15 


Electricity, . 


• 9 


Skin Diseases, . . .12- 


Gynaecology, 


. 10 


Surgery and Bandaging, . 13. 


Hygiene, 


• 9 


Therapeutics, . . 9 


Materia Medica, . 


• 9 


Urine and Urinary Organs, 13; 


Medical Jurisprudence 


. 10 


Venereal Diseases, . . 13. 


Nervous Diseases, 


. 10 





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No. 1. SURGERY. 318 Illustrations. 
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318 Illustrations. 

Presents the introductory facts in Surgery in clear, precise 
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No. 2. DISEASES OF WOMEN. 150 Lllus. 

NEW EDITION. 

The Diseases of Women. Including Diseases of the 
Bladder and Urethra. By Dr. F. Winckel, Professor 
of Gynaecology and Director of the Royal University 
Clinic for Women, in Munich. Second Edition. Re- 
vised and Edited by Theophilus Parvin, M.D., 
Professor of Obstetrics and Diseases of Women and 
Children in Jefferson Medical College. 150 Engrav- 
ings, most of which are original. 
" The book will be a valuable one to physicians, and a safe and 

satisfactory one to put into the hands of students. It is issued in a 

neat and attractive form, and at a very reasonable price." — Boston 

Medical and Surgical Journal . 

No. 3. OBSTETRICS. 227 Illustrations. 

A Manual of Midwifery. By Alfred Lewis Galabin, 
m.a., m.d., Obstetric Physician and Lecturer on Mid- 
wifery and the Diseases of Women at Guy's Hospital, 
London; Examiner in Midwifery to the Conjoint 
Examining Board of England, etc. With 227 Illus. 
" This manual is one we can strongly recommend to all who 
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Students at the present time not only are expected to know the 
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it will be regarded as one of the most important text-books on the 
subj ect.' ' — London Practitioner. 

No. 4. PHYSIOLOGY. Fifth Edition. 

321 ILLUSTRATIONS AND A GLOSSARY. 
A Manual of Physiology. By Gerald F. Yeo, m.d., 
f.r.C s., Professor of Physiology in King's College, 
London. 321 Illustrations and a Glossary of Terms. 
Fifth American from last English Edition, revised and 
improved. 758 pages. 

This volume was specially prepared to furnish students with a 
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as are unnecessary for students in our medical colleges. 

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6 STUDENTS' TEXT-BOOKS AND MANUALS. 

ANATOMY. 

Morris' New Text-Book on Anatomy. 700 Specially En- 
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known writers. Octavo. Nearly Ready. Price about 6.00 
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Macalister's Human Anatomy. 816 Illustrations. A new 
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of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 

Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations. 
X2mo. Cloth, 1. 00; Interleaved for notes, 1.25 

Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. 

Bound in Oilcloth, for the Dissecting Room, $4.50. 

Holden's Human Osteology. Comprising a Description of the 
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Muscles. The General and Microscopical Structure of Bone and 
its Development. With Lithographic Plates and Numerous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 

Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 
Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. See Page 14. 

Cloth, 1.00; Interleaved for Notes, 1.25 

CHEMISTRY. 
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Trimble. Practical and Analytical Chemistry. A Course in 
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Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
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Mtf* See Pages 2 to 5 for list of Students* Manuals . 



STUDENTS' TEXT-BOOKS AND MANUALS. 7 

Chemistry : — Continued. 

Richter's Inorganic Chemistry. Fourth American, from Sixth 
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89 Wood Engravings and Colored Plate of Spectra. Cloth, 2.00 

Richter's Organic Chemistry, or Chemistry of the Carbon 
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Symonds. Manual of Chemistry, for the special use of Medi- 
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Physician Roosevelt Hospital, Out- Patient Department; Attend- 
ing Physician Northwestern Dispensary, New York. Cloth, 2.00 

Leffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition.' Revised. 
See page 15. Cloth, 1.00; Interleaved for Notes, 1.25 

Leffmann and Beam. Progressive Exercises in Practical 
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Muter. Practical and Analytical Chemistry. Fourth Edi- 
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Colleges, by Prof. C. C. Hamilton. Illustrated. Cloth, 2.00 

Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. Fourth 
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Van Niiys. Urine Analysis. Illus, Cloth, 2.00 

CHILDREN. 

Goodhart and Starr. The Diseases of Children. Second 
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Starr. Diseases of the Digestive Organs in Infancy and 
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Harris. Principles and Practice of Dentistry. Including 
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Richardson's Mechanical Dentistry. Fifth Edition. 569 
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Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 
Taft's Operative Dentistry. Dental Students and Practitioners. 
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Talbot. Irregularities of the Teeth, and their Treatment. 
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Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. 292 Illus. Cloth, 5.00 
Warren. Compend of Dental Pathology and Dental Medi- 
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Gould's New Medical Dictionary. Containing the Definition 
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Gould's Pocket Dictionary. 12,000 Medical Words Pro- 
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Harris' Dictionary of Dentistry. Fifth Edition. Completely 
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Cleaveland's Pronouncing Pocket Medical Lexicon. Small 
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Longley's Pocket Dictionary. The Student's Medical Lexicon, 
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Parkes* (L. C.) Manual of Hygiene and Public Health. 
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Cooper Medical College, San Francisco. Fourth Revised and 
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White and Wilcox. Materia Medica, Pharmacy, Phar- 
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10 STUDENTS' TEXT-BOOKS AND MANUALS. 



MEDICAL JURISPRUDENCE. 

Reese. A Text-book of Medical Jurisprudence and Toxi- 
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NERVOUS DISEASES. 

Gowers. Manual of Diseases of the Nervous System. 
A Complete Text-book. By William R. Gowers, m.d., Prof. 
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Vol. I. Diseases of the Nerves and Spinal Cord. 616 

pages. Cloth, 3.50 

Vol. II. Diseases of the Brain and Cranial Nerves. 
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Ormerod. Diseases of Nervous System, Student's Guide to. 
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ological. Clinical, Ophthalmological, and Neurological Societies, 
Physician to National Hospital for Paralyzed and Epileptic and 
to City of London Hospital for Diseases of the Chest, Demon- 
strator of Morbid Anatomy, St. Bartholomew's Hospital, etc. 
With 75 Wood Engravings. Cloth, 2.00 

OBSTETRICS AND GYNAECOLOGY. 

Davis. A Manual of Obstetrics. By Edw. P. Davis, Clinical 
Lecturer on Obstetrics, Jefferson Medical College, Philadelphia.. 
Colored Plates, and 130 other Illustrations. i2mo. Cloth, 2.00 

Byford. Diseases of Women. The Practice of Medicine and 
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Woman's Hospital of Chicago. Fourth Edition. Revised and 
Enlarged. 306 Illustrations, over 100 of which are original. 
Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 

Lrewers' Diseases of "Women. A Practical Text-book. 139 
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Parvin's Winckel's Diseases of "Women. Second Edition. 
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150 Illus. Revised. See page 3. Cloth, 3.00; Leather, 3.50 

Morris. Compend of Gynaecology. Illustrated. Cloth, 1.00 

"Winckel's Obstetrics. A Text-book on Midwifery, includ- 
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of Gynaecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J. Clifton 
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J9&~ See pages 2 to 5 for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 11 

Obstetrics and Gynecology : — Continued. 
Landis' Compend of Obstetrics. Illustrated. 4th Edition,, 
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Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p. 
227 Illustrations. Seepages. Cloth, 3.00; Leather, 3.50 

PATHOLOGY, HISTOLOGY, ETC. 

Wethered. Medical Microscopy. By Frank J. Wethered, 
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Bowlby. Surgical Pathology and Morbid Anatomy, for 
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Tyson's Student's Handbook of Physical Diagnosis. Illus- 
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Yeo's Physiology. Fifth Edition. The most Popular Stu- 
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Landois' Human Physiology. Including Histology and Micro- 
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Sanderson's Physiological Laboratory. Being Practical Ex- 
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PRACTICE. 

Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
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49* See pages 14 and IS for list 0/ ? Quiz-Compends t 



12 STUDENTS' TEXT-BOOKS AND MANUALS. 

Practice : — Continued. 

Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d., m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50; Sheep, 6.50 

Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 

Part i. — Continued, Eruptive and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc., and General Diseases, etc. 

Part ii. — Diseases of the Respiratory System, Circulatory 
System, and Nervous System; Diseases of the Blood, etc. 

Physicians* Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index. 1 vol. Full Morocco, Gilt, 2.50 

From John A. Robinson, M.D., Assistant to Chair of Clinical 
Medicine t now Lecturer on Materia Medica, Rush Medical Col- 
lege, Chicago. 
'* Meets with my hearty approbation as a substitute for the 

ordinary note books almost universally used by medical students. 

It is concise, accurate, well arranged, and lucid, . . . just the 

thing for students to use while studying physical diagnosis and the 

more practical departments of medicine." 

PRESCRIPTION BOOKS. 

Wythe's Dose and Symptom Book. Containing the Doses 
and Uses of all the principal Articles of the Materia Medica, etc. 
Seventeenth Edition. Completely Revised and Rewritten. Just 
Ready. 32mo. Cloth, 1. 00; Pocket-book style, 1.25 

Pereira's Physician's Prescription Book. Containing Lists 
of Terms, Phrases, Contractions, and Abbreviations used in 
Prescriptions, Explanatory Notes, Grammatical Construction of 
Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. 
Sixteenth Edition. 32mo. Cloth, 1.00; Pocket-book style, 1.25 

PHARMACY. 

Stewart's Compend of Pharmacy. Based upon Remington's 
Text-book of Pharmacy. Third Edition, Revised. With new 
Tables, Index, Etc. Cloth., 1.00 ; Interleaved for Notes, 1.25 

Robinson. Latin Grammar of Pharmacy and Medicine. 
By H. D. Robinson, ph.d., Professor of Latin Language and 
Literature, University of Kansas, Lawrence. With an Intro- 
duction by L. E. Sayre, ph.g., Professor of Pharmacy in, and 
Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. 

Cloth, 2.00 

SKIN DISEASES. 

Anderson, (McCall) Skin Diseases. A complete Text-book, 
with Colored Plates and numerous Wood Engravings. 8vo. 

Cloth, 4.50; Leather, 5.50 

Van Harlingen on Skin Diseases. A Handbook of the Dis- 
eases of the Skin, their Diagnosis and Treatment (arranged alpha- 
betically). By Arthur Van Harlingen, m.d., Clinical Lecturer 
on Dermatology, Jefferson Medical College ; Prof, of Diseases of 
the Skin in the Philadelphia Polyclinic. 2d Edition. Enlarged. 
With colored and other plates and illustrations. i2mo. Cloth, 2.50 
See pages 2 to 5 for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. IS 
SURGERY AND BANDAGING. 

Moullin's Surgery. 500 Illustrations (some colored), 200 of 
which are original. 2d Ed. Cloth, net 7.00; Leather, net 8.00 

Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students, and Hospital Surgeons. By W. H. A. 
Jacobson, b a. Oxon., f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- 
pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 

Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 

Horwitz's Compend of Surgery, Minor Surgery and 
Bandaging, Amputations, Fractures, Dislocations, Surgical 
Diseases, and the Latest Antiseptic Rules, etc., with Differential 
Diagnosis and Treatment. By Orville Horwitz, b.s., m.d., 
Demonstrator of Surgery, Jefferson Medical College. 4th edition. 
Enlarged and Rearranged. 136 Illustrations and 84 Formulae. 
i2mo. Cloth, 1. 00 ; Interleaved for the addition of Notes, 1.25 
*:}.*The new Section on Bandaging and Surgical Dressings con- 
sists of 32 Pages and 41 Illustrations. Every Bandage of any 
importance is figured. This, with the Section on Ligation of 
Arteries, forms an ample Text-book for the Surgical Laboratory. 

Walsham. Manual of Practical Surgery. Third Edition. 
By Wm. J. Walsham, m.d., f.r c s., Asst. Surg, to, and Dem 
of Practical Surg, in, St. Bartholomew's Hospital; Surgeon to 
Metropolitan Free Hospital, London. With 318 Engravings. 
See j>age 2. Cloth, 3. 00; Leather, 3.50 

URINE, URINARY ORGANS, ETC. 

Holland. The Urine, and Common Poisons and The 
Milk. Chemical and Microscopical, for Laboratory Use. Illus- 
trated. Fourth Edition. i2mo. Interleaved. Cloth, 1.00 

Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- 
trations, nmo. 572 pages. Cloth, 2.75 

Marshall and Smith. On the Urine. The Chemical Analysis or 
the Urine. By John Marshall, m.d., Chemical Laboratory, Univ. 
of Penna; and Prof. E. F. Smith, ph.d. Col. Plates. Cloth, 1.00 

Memminger. Diagnosis by the Urine. Illustrated. 

Cloth, 1.00 

Tyson. On the Urine. A Practical Guide to the Examination 
of Urine. With Colored Plates and Wood Engravings. 7th Ed. 
Enlarged. i2mo. Cloth, 1.50 

Van Niiys, Urine Analysis. Illus. Cloth, 2.0a 

VENEREAL DISEASES. 

Hill and Cooper. Student's Manual of Venereal Diseases, 
with Formula?. Fourth Edition. i2mo. Cloth, 1.0a 

See pages 14 and 15 for list of ? Quiz- Contp ends f 



PQUIZ-COMPENDS? 

The Best Compends for Students' Use 
in the Quiz Class, and when Pre- 
paring for Examinations. 

Compiled in accordance with the latest teachings of promi- 
nent Lecturers and the most popular Text-books. 

They form a most complete, practical, and exhaustive 
set of manuals, containing information nowhere else col- 
lected in such a condensed, practical shape. Thoroughly 
up to the times in every respect, containing many new 
prescriptions and formulae, and over two hundred and 
fifty illustrations, many of which have been drawn and 
engraved specially for this series. The authors have had 
large experience as quiz-masters and attaches of colleges, 
with exceptional opportunities for noting the most recent 
advances and methods. 

Cloth, each $1.00. Interleaved for Notes, $1.25. 

No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New 
Tables, and 117 other Illustrations. By Samuel O. L. 
Potter, m.a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon U. S. 
Army, Professor of Practice, Cooper Medical College, San Fran- 
cisco. 

Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 

Part I. — Continued, Eruptive, and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Phy- 
sical Diagnosis), Circulatory System, and Nervous System; Dis- 
eases of the Blood, etc. 

*#* These little books can be regarded as a full set of notes upon 
the Practice of Medicine, containing the Synonyms, Definitions, 
Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each 
disease, and including a number of prescriptions hitherto unpub- 
lished. 

No. 4. PHYSIOLOGY, including Embryology. Sixth 
Edition. By Albert P. Brubaker, m.d., Prof, of Physiology, 
Penn'a College of Dental Surgery; Demonstrator of Physiology 
in Jefferson Medical College, Philadelphia. Revised, Enlarged, 
with new Illustrations. 

No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
Henry G. Landis, m.d., Prof, of Obstetrics and Diseases of 
Women in Starling Medical College, Columbus, O. Revised 

Edition. New Illustrations. 



BLAKISTON'S ? QUIZ-COMPENDS ? 

;No. 6. MATERIA MEDICA, THERAPEUTICS, AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 
With especial Reference to the Physiological Action of Drugs, 
and a complete article on Prescription Writing. Based on the 
Last Revision of the U. S. Pharmacopoeia, and including many 
unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., 
m.r.c.p. (Lond.), late A. A. Surg. U. S. Army ; Prof, of Practice, 
Cooper Medical College, San Francisco. Improved and Enlarged, 
with Index. 

'No. 7. GYNECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson 
Medical College, Philadelphia. 45 Illustrations. 

Wo. 8. DISEASES OF THE EYE AND REFRACTION, 

including Treatment and Surgery. By L. Webster Fox, m.d., 
Chief Clinical Assistant Ophthalmological Dept., Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulae. Second Enlarged and improved Edition. Index. 

No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
Dislocations, Sprains, Amputations, and other operations; Inflam- 
mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College. Revised 
and Enlarged. 84 Formulae and 136 Illustrations. 

No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in 
Penn'a College of Dental Surgery, Phila. Third Edition, Revised 
and Rewritten, with Index. 

'No. 11. PHARMACY. Based upon " Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph. g., Quiz-Master 
at Philadelphia College of Pharmacy. Third Edition, Revised. 

No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R. Ballou, m.d., Prof, of 
Equine Anatomy at N. Y. College of Veterinary Surgeons. 

No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. By Geo. W. Warren, d.d.s., Clinical 
Chief, Penn'a College of Dental Surgery, Philadelphia. Illus. 

No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Colored Plate. 

"Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 



These books are constantly revised to keep up with 
the latest teachings and discoveries, so that they contain 
all the new methods and principles. No series of books 
are so complete in detail, concise in language, or so well 
printed and bound. Each one forms a complete set of 
notes upon the subject under consideration. 

Illustrated Descriptive Circular Free. 



GOULD'S NEW 

Medical Dictionary. 

Based on Recent Medical Literature. 




Small 8vo, Half Morocco, as above, with Thumb Index, . . $4.25 
Plain Dark Leather, without Thumb Index, 3.25 



A compact, concise Vocabulary, including all 
the Words and Phrases used in medicine, with 
their proper Pronunciation and Definitions. 



" One pleasing feature of the book is that the reader can almost 
invariably find the definition under the word he looks for, without 
being referred from one place to another, as is too commonly the 
case in medical dictionaries. The tables of the bacilli, micrococci, 
leucomai'nes and ptomaines are excellent, and contain a large 
amount of information in a limited space. The anatomical tables 
are also concise and clear. . . . We should unhesitatingly 
recommend this dictionary to our readers, feeling sure that it will 
prove of much value to them/' — American Journal of Medical 
Science. 

JUST PUBLISHED. 
GOULD'S POCKET DICTIONARY. 12,000 
Medical Words Pronounced and Defined. 

Cloth, $1.00; Leather, #1.25 






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